Contract Pharmacy Details

ST MARY HEALTH VENTURES
RWI39 CHW-CARE PROGRAM AND CLINICS

Covered Entity Details

Entity Name

CHW-CARE PROGRAM AND CLINICS

Subdivision Name

ST. MARY MEDICAL CENTER

Type

Ryan White Part A

340B ID

RWI39

Entity Address

1043 ELM AVENUE
SUITE 300
LONG BEACH, CA 90813

Grant Number

LOS ANGELES EMA / H89HA00016

Participating Start Date

12/1/1992

Last Recertification Date

2/10/2017

Entity Termination Date

4/1/2018

Pharmacy Details

Pharmacy Name

ST MARY HEALTH VENTURES

Pharmacy Address

DBA MEDICAL MALL PHARMACY
1040 ELM AVE STE 104
LONG BEACH, CA 90813

Pharmacy Comments

Contract Details

Approval Date

12/31/2002

Contract Begin Date

12/31/2002

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2017
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Mario J. Perez, Office of AIDS Programs & Policy
(213) 351-8001

Contract Pharmacy Representative

St Mary Medical Center
Catherine Hirokawa, Director of Pharmacy
(562) 491-9773

Signed By Date

10/12/2011

340B Drug Pricing Program Database