Contract Pharmacy Details

MARVIN LIEBLEIN, INC
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

MARVIN LIEBLEIN, INC

Pharmacy Address

DBA FAMILY PHARMACY
1400 ATLANTIC AVE
LONG BEACH, CA 90813

Pharmacy Comments

Contract Details

Approval Date

4/16/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/2/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Miguel Gutierrez, Sr. Clinic Operations Administrator
(562) 491-9267 Ext: 3267

Contract Pharmacy Representative

Marvin Lieblein, Owner
(562) 591-4417

Signed By Date

4/16/2015

340B Drug Pricing Program Database