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GAGE PHARMACY
CHC26616-00 BENEVOLENCE INDUSTRIES INCORPORATED
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Covered Entity Details
Entity Name
BENEVOLENCE INDUSTRIES INCORPORATED
Subdivision Name
Benevolence Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26616-00
Entity Address
611 E. Imperial Highway
Suite 107
Los Angeles, CA 90059
Grant Number
H80CS26616
Participating Start Date
4/1/2015
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
GAGE PHARMACY
Pharmacy Address
AGMMM PHARMACY INC
5735 ATLANTIC AVE
LONG BEACH, CA 90805
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kwabena Obeng, CEO
(310) 800-7963
Contract Pharmacy Representative
Gage Pharmacy
Atteff Girgis, Pharmacist
(562) 423-8437
Signed By Date
4/16/2018
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