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MANCHESTER PROFESSIONAL PHARMACY
CH09244B CLINIC INC, THE
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Covered Entity Details
Entity Name
CLINIC INC, THE
Subdivision Name
T.H.E. Clinic Inc. at Lennox School District
Type
HRSA-Funded Health Center
340B ID
CH09244B
Entity Address
10223 Firmona Ave
Lennox, CA 90304-1421
Grant Number
H80CS00755
Participating Start Date
4/1/2015
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
MANCHESTER PROFESSIONAL PHARMACY
Pharmacy Address
NO APARTMENT
600 W MANCHESTER AVE
LOS ANGELES, CA 90044-5770
Pharmacy Comments
Contract Details
Approval Date
1/9/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clifford Shiepe, President and CEO
(323) 730-1920 Ext: 3053
Contract Pharmacy Representative
Hawthorne Professional Pharmacy
Janice Cooper, PharmD
(213) 999-0428
Signed By Date
1/9/2018
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