Contract Pharmacy Details

LAC PHARMACIES INC
FQHCLA278C CENTRAL NEIGHBORHOOD HEALTH FOUNDATION

Covered Entity Details

Entity Name

CENTRAL NEIGHBORHOOD HEALTH FOUNDATION

Subdivision Name

Central Neighborhood Health Foundation H Street Clinic

Type

Health Center Program Look-Alike

340B ID

FQHCLA278C

Entity Address

1329 N H ST
SAN BERNARDINO, CA 92405-5039

Grant Number

LALCS00088

Participating Start Date

1/1/2017

Last Recertification Date

2/7/2018

Entity Termination Date

4/1/2018

Pharmacy Details

Pharmacy Name

LAC PHARMACIES INC

Pharmacy Address

2150 N WATERMAN AVE STE 104
DBA WATERMAN PHARMACY
SAN BERNARDINO, CA 92404-4811

Pharmacy Comments

Contract Details

Approval Date

1/13/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Bassett Brown, Chief Executive Officer
(626) 252-5646

Contract Pharmacy Representative

Verity Solutions
kartik Joneja, 3rd party admiinistrator
(415) 260-6540

Signed By Date

1/13/2018

340B Drug Pricing Program Database