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Thriving Amidst the Huge CVS and Rite-Aid Chains, Corner Drug Stores Create an Important Community in L.A. Little Tokyo Pharmacy's Mi Sook Cho Photo by Star Foreman "Great to see you guys," the clerk at Eddie's Pharmacy in West Hollywood greets a couple of men, one blind and being helped by the other. And they're just as glad to see the clerk. It's another small-town exchange in sprawling Los Angeles, home to dozens of neighborhood drugstores that the giant chains have not yet gobbled up. Although thousands of Los Angeles residents rely on the special approaches and customized medical knowledge offered by friendly corner pharmacies, the big-box drugstores are steadily wiping out their smaller competition. pre bonded hairFifteen to 20 years ago, most prescriptions in California were filled by independent pharmacies. Now, the chains are looming — and pervasive. Huge Rite-Aid, which gobbled up Thrifty years ago — but kept its beloved ice cream — has agreed to be taken over by Walgreens. Also awaiting approval by antitrust regulators is CVS' purchase of Target's pharmacies earlier this year. John Ball, longtime manager of Lorena Pharmacy in Boyle Heights, says that contrary to the claims of Big Pharma, it's the little guys with their attentive service that save the huge pharmaceutical system money. "Our pharmacists perform tons of triage," he says, adding, "A lot of times [a problem] can be solved over the counter," thus saving a doctor's visit. L.A.'s independent pharmacies, each surprisingly distinct from the others, reflect the essence of the neighborhoods in which they operate. But the big chains have the advantage. They can withstand a fiscal hit during hard times, and a percentage of their customers is encouraged by insurers to use specific in-network providers. Some customers are influenced by insurance information mailed complete with a chain's logo on it, inaccurately implying that the patient must use that chain. The big pharmacies know the independents are in trouble. Ball says, "CVS sends letters every month [saying] that they'd like to buy." Dr. Babic Babikian of B&G in Little Armenia says he all but "collects those letters." Babic G. Babikian, owner of B&G Pharmacy

Photo by Star Foreman In addition to these advantages for the big-box stores, a so-called "pharmacy benefit manager" now acts as a middleman between each pharmacy and the insurance and pharmaceutical companies. The powerful PBMs set rates of reimbursement from the insurers and negotiate prices with the pharmaceutical companies. And they can refuse to reimburse pharmacies for as small a reason as a typographical error in their records. According to Ball, PBMs fail to boost reimbursements for independent pharmacies when drug prices go up, forcing small entities to take a loss on some drugs. And their surprise audits of records are aggressive. Dr. Ike of Dr. Ike's Pharmacy in Studio City says, "Because of the state we're in with the insurance, our contracts get worse every year and it's in the insurance contract [that] 'next year we're going to actually pay you worse and the following year it's going to be even worse.' We sign it because we have pretty much no other choice." He explains, "The average cost of dispensing a drug in America is $11 and they're sometimes getting paid 44 cents on a medication. ... A lot of times we dispense a drug and we [end up] negative." remy hair extensionsBut many of L.A.'s little-guy pharmacies abhor cutting staff to make up for losses — they pride themselves on their delivery of customer service. L.A. Weekly looked at a sampling of local community pharmacies that showcase their independence, letting our imagination play off of their less-homogenized physical environments, taking note of how they reflect and connect with their neighborhoods through the often passionate people employed within. Strolling through South Pasadena can be a trip down memory lane, past a house with a white picket fence and trellised entrance, past a closed Radio Shack, and into the Fair Oaks Pharmacy and Soda Fountain. This former Route 66 rest stop, a still-active corner drugstore at 1526 Mission St., has made it to age 100. Fair Oaks Pharmacy and Soda Fountain, in South Pasadena, is a century old.

Photo by Star Foreman Inside, friendly clerks and soda jerks joke with customers who sit on stools that really spin, eat hand-dipped malts or buy books with relatable titles like The Shy Little Kitten. The shop challenges customers' palates with Crick-ettes — suckers embedded with real scorpions. From the candy section, vintage swinging doors give a peek at the pharmacists as customers pick up their prescriptions. Fair Oaks Pharmacy is often described as Leave It to Beaver, but that family sitcom featured just one black performer on a single episode during its six-year run. Fair Oaks has diverse staff and customers, and on a recent day at its outside tables, someone wearing rasta colors was speaking patois. The pharmacist and owner, Zahra Shahniani, is from Iran. Shahniani knows her customers — in fact, her sons attend school with many of their children. A store manager, Rachel Pabon, reveals one of the more personal aspects of their philosophy: Fair Oaks "will hold the charge and never let someone walk out without medicine because they don't have the money." About eight miles south of Fair Oaks Pharmacy and Soda Fountain, Lorena Pharmacy welcomes a predominantly Latino clientele with its sign "Especialidad en Recetas." perruques cheveux naturelsLorena opened in 1928 and serves three generations at 3400 Whittier Blvd., including those who left Boyle Heights long ago and still drive in from distant suburbs such as Corona to fill their prescriptions. The surrounding area offers 24-hour tacos and a video store that still gets new movies every week. The drugstore is well-staffed and spirited, with a couple of pharmacists often in direct consultation with customers. If Spanish is needed and that particular pharmacist can't speak it, the clerk will translate. "The days of most indie pharmacies are numbered." —John Ball, manager of Lorena Pharmacy in Boyle Heights The front of the shop has a wonderful selection of products: Get lost in an examination of the extensive referencia de hierbas list. For example, damiana is said to help with impotency and nerves, while romero (rosemary) may help hypertension. Pick up some extracto de sapuyulo and destroy dandruff. But Ball says that, despite the store's bustling appearance, if something doesn't change, "The days of most indie pharmacies are numbered, and it's not five or 10 years away, it's one or two." Unlike, say, a hardware store, pharmacies cannot charge a little extra to stay afloat. "If you took at a survey of the community, they'd all prefer to come to [Lorena]," Ball says. "There's nothing more important than health — the main thing is patient care when a family member is sick. Don't say goodbye to the community pharmacy." Little Tokyo Pharmacy carries items approved by the Japan Toothbrush Association.

Photo by Star Foreman Three miles west of Lorena Pharmacy, in downtown Los Angeles, pharmacist Mi Sook Cho makes people feel happy at Little Tokyo Pharmacy. She has curly hair and glasses and smiles when she meets new people. When an insurance company denies coverage of a drug, Cho comes out to the waiting area and discusses options with her elderly customers. Little Tokyo Pharmacy is not heavy on beauty items, because nearby stores burst with products such as Japanese hair dye in raspberry macaroon or milk tea brown. The druggist is located in Honda Plaza, just half a block up Second Street from the Japanese Village Plaza with its red lanterns and wishing tree. There, you may spot a visiting Japanese businessman talking on his cellphone as he uses the ledge of a peaceful rock fountain as a table. The pharmacy evokes its surroundings, displaying a wall of winning lottery tickets to fuel fantasies, and a full line of interdental brushes "whose size indication is made in accordance with the voluntary control of the Japan Toothbrush Association." And it stocks Japan's No. 1 energy shot. Morningside Medical Pharmacy, owned by Dr. Remy C. Mgbojirikwe, focuses on management of diseases such as diabetes. Photo by Star Foreman perruques cheveuxEight miles south of Little Tokyo, the South Los Angeles working-class community of Gramercy Park has a personal relationship with Morningside Pharmacy, a shop that has been at the corner of Manchester Avenue and Harvard Boulevard since 1958 — the year the Dodgers moved to L.A. At one time the pharmacy was part of the complex that housed Morningside Hospital, where many of its customers were born. The neighborhood has a Happy Fish restaurant, liquor store and a park a couple of blocks away where children can run through water spraying from a sprinkler shaped like a flower. The hospital was closed in the early 1980s and later demolished, but not before Halloween II (1981) was shot inside one of its wings. Pharmacist Remy C. Mgbojirikwe moved to the United States from Nigeria when he was 23. A warm presence, he points out the TV he set up so customers can relax while they wait for an order. Dr. Mgbojirikwe does a lot of medical and diabetes management and focuses on relieving people's anxiety — "When you come in to an independent and walk in, of course I'm there to talk to you one-on-one," he says. "And all of a sudden, I'm your friend." He says pharmacists need to pay attention to whether prescribed drugs are safe to take together, because people often see different medical specialists. He'll consult with a doctor if a customer isn't getting medication he thinks may be needed, for example, to better protect their kidneys. Mgbojirikwe came from CVS and bought Morningside in 2008 from the previous owner of 33 years. He jokes, "Then I modeled the store to look like CVS, where I came from." In his locale not far from Inglewood, Mgbojirikwe likes to help out at events as the neighborhood pharmacist. And, he says, a local community association looks out for him as well. Eddie's Pharmacy

Photo by Star Foreman Nine miles to the north in upscale West Hollywood, a framed article from the 1990s describes the then-new Eddie's Pharmacy as a "stark, airy interior, a bit more Bauhausian than your run-of-the-mill drugstore." The now-retired Eddie Bubar added personal touches to his store at 8500 Melrose Ave., such as his photo of an orangutan, which still hangs near his old desk; the new owner kept it in place. Clippings and booster buttons still on display make it obvious that Bubar is a big USC Trojans fan. When Dr. Sepehr "Sam" Mansuri bought the pharmacy from Bubar three years ago, he wanted it to still feel like home, in this area surrounded by high-end stores. Eddie's has a relationship with many of the doctors at nearby Cedars-Sinai Hospital. It's a general pharmacy (so it happily serves UCLA Bruins students and alums, too), but because of its location it has a special commitment to the treatment of HIV/AIDS. "Unlike a CVS that is built to do volume, we're really built to cater to specific needs of the community," says Mansuri, another refugee from CVS. Often Mansuri will talk over care options with someone who has just received an HIV/AIDS diagnosis from a doctor who may not have had enough time for counseling. Mansuri makes sure patients know what they're taking and why — and he'll advocate to a doctor on behalf of a patient. He lets people know that even if they aren't the patient — say they're concerned about a loved one — they're free to stop in. "We never let someone walk out without medicine because they don't have the money." —Zahra Shahniani, owner of Fair Oaks Pharmacy and Soda Fountain Mansuri says he loves getting up in the morning and going to his job. He feels "really fortunate" and hopes to work at Eddie's Pharmacy until he retires.lace front wigs Four miles due north in the San Fernando Valley, Dr. Ike's Pharmacy at 11736 Ventura Blvd. in Studio City serves its clientele by being an "anti-drug druggist." There, Dr. Ayk Dzhragatspanyan, as his website states, is "known to all as simply Dr. Ike." His practices may sound like stereotypical laid-back California, but he uses a research-based approach and spends time learning what can be done with natural treatments versus drugs. In pharmacy school, students may study the hypothetical case of a 40-year-old patient presenting with Type 2 diabetes, and the standard drug treatment response. Ike asks, "Why don't you stop for a second and address why a 40-year-old is coming in with [this condition]? Because 20 years ago, 40-year-olds were not coming in with Type 2 diabetes." He tries to determine if it's possible to help a person fight a disease without first resorting to drugs to control the symptoms. Of course, he says, "Some people, they still need medication," but his perspective is, "there's a time and place." Ike emphasizes vitamins that complement almost every pharmaceutical by providing, he says, side-effect protection, nutrient restoration and organ protection. He says that approach has meant "a night-and-day difference" for his customers who didn't feel right. B&G Pharmacy

Photo by Star Foreman Six miles to the southeast, in the Little Armenia section of East Hollywood, English and Armenian lettering and a green-and-white awning adorn a corner pharmacy gem, B&G Pharmacy, just down the boulevard from the widely known Jumbo's Clown Room lounge. cosplay wigsDr. Babic Babikian established his practice at 5101 Hollywood Blvd. in 1980, two years before Jumbo's introduced its pole dancers. His store features an appealing wall that displays gift-wrap options, gold-laced cards and Armenian booklets. Walk around the corner and you may catch older Armenians in a front apartment patio shooting the breeze in their native tongue. B&G operates from a humanist view. The community he serves is low-income. "Most important is to know your patient — a pharmacist should not be something disposable. It's a crude way of comparing it, but you shouldn't just change it like you change your underwear," Babikian says as he stands in his shop's waiting area. The lively pharmacist, dressed in a plaid shirt, explains that people need to feel comfortable with their pharmacist, able to sit down and ask questions. Of the corporate drugstore chains that are merging into bigger and bigger giants, he dismissively says, "All that they look at is numbers, and those decisions are made by individuals that are so distant from the consumer, so distant, numbers is all they look at." He has a warning for those who still cherish a corner drugstore in Los Angeles. "As individuals, as consumers, we have to protect the independents, it's our interest — it's our personal interest," he says.