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VERMONT V O PHARMACY
CHC08241-00 MISSION CITY COMMUNITY NETWORK
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Covered Entity Details
Entity Name
MISSION CITY COMMUNITY NETWORK
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08241-00
Entity Address
15206 PARTHENIA STREET
NORTH HILLS, CA 91343
Grant Number
H80CS08241
Participating Start Date
7/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
VERMONT V O PHARMACY
Pharmacy Address
2655 W OLYMPIC BL #104
LOS ANGELES, CA 90006-2800
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nik Gupta, CEO
(818) 895-3100
Contract Pharmacy Representative
Vermont V.O. Pharmacy
Edward Lee, Pharmacist
(213) 480-1503
Signed By Date
4/13/2018
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