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IMANOEL 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
IMANOEL PHARMACY
Pharmacy Address
DBA SUNSHINE PHARMACY
357 N FAIRFAX AVE
LOS ANGELES, CA 90036
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
National Pharmacy
MICHAEL M. IMANOEL, PRESIDENT
(323) 851-4444
Signed By Date
1/15/2018
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