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LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
CHC08241-13 MISSION CITY COMMUNITY NETWORK, INC.
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Covered Entity Details
Entity Name
MISSION CITY COMMUNITY NETWORK, INC.
Subdivision Name
Mission CIty Community Network- Fairfax
Type
HRSA-Funded Health Center
340B ID
CHC08241-13
Entity Address
359 N. Fairfax Avenue-2nd Floor
Los Angeles, CA 90036-9007
Grant Number
H80CS08241
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
LOS ANGELES COUNTY HEALTH SERVICES CENTRAL PHARMACY
Pharmacy Address
313 N FIGUEROA STREET
SUITE 1225
LOS ANGELES, CA 90012
Pharmacy Comments
Contract Details
Approval Date
1/9/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
DHS
Shane D'Souza, Pharmacy Services Chief II
(213) 240-7717
Signed By Date
1/9/2018
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