Contract Pharmacy Details

RX CENTRAL
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

RX CENTRAL

Pharmacy Address

IMANOEL PHARMACY, INC. DBA
800 S. CENTRAL AVENUE
SUITE 101A
GLENDALE, CA 91204-4375

Pharmacy Comments

Contract Details

Approval Date

1/15/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Nik Gupta, CEO
(818) 895-3100

Contract Pharmacy Representative

Rx Central Pharmacy
Mosha seleh, Pharmacist
(818) 244-5062

Signed By Date

1/15/2018

340B Drug Pricing Program Database