Contract Pharmacy Details

THE MEDICINE SHOPPE
CHC08241-21 MISSION CITY COMMUNITY NETWORK, INC.

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK, INC.

Subdivision Name

Mission City Community Network - Victorville2

Type

HRSA-Funded Health Center

340B ID

CHC08241-21

Entity Address

14357 7th Street
Victorville, CA 92395-9239

Grant Number

H80CS08241

Participating Start Date

4/1/2017

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

THE MEDICINE SHOPPE

Pharmacy Address

15555 MAIN STREET #D8
HESPERIA, CA 92345-3423

Pharmacy Comments

Contract Details

Approval Date

2/16/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/10/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

HUSAM IBRAHIM HASAN ABUKHIRAN, PHARMACIST
(760) 948-1000

Signed By Date

340B Drug Pricing Program Database