Contract Pharmacy Details

CRENSHAW PHARMACY INC
CHC08241-24 MISSION CITY COMMUNITY NETWORK, INC.

Covered Entity Details

Entity Name

MISSION CITY COMMUNITY NETWORK, INC.

Subdivision Name

Mission City Community Network- Olympic

Type

HRSA-Funded Health Center

340B ID

CHC08241-24

Entity Address

2655 West Olympic Blvd.
Los Angeles, CA 90006

Grant Number

H80CS08241

Participating Start Date

1/1/2018

Last Recertification Date

2/1/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

CRENSHAW PHARMACY INC

Pharmacy Address

DBA CRENSHAW PHARMACY
3631 CRENSHAW BLVD #111
LOS ANGELES, CA 90016

Pharmacy Comments

Contract Details

Approval Date

1/12/2018

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

Crenshaw Pharmacy
KOHANCHI NASTARAN ESTHER, PHARMACIST
(323) 732-5555

Signed By Date

1/12/2018

340B Drug Pricing Program Database