340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
FAIR OAKS COMMUNITY PHARMACY
DSH050113A SAN MATEO MEDICAL CENTER
Print
Covered Entity Details
Entity Name
SAN MATEO MEDICAL CENTER
Subdivision Name
SAN MATEO COUNTY MEDICAL CENTER / Mobile Clinic
Type
Disproportionate Share Hospital
340B ID
DSH050113A
Entity Address
222 W 39TH AVE
SAN MATEO, CA 94403
Medicare Provider Number
050113
Outpatient Facility Provider Number
Participating Start Date
7/1/2015
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
FAIR OAKS COMMUNITY PHARMACY
Pharmacy Address
2710 MIDDLEFIELD ROAD, SUITE 125
REDWOOD CITY, CA 94063
Pharmacy Comments
Contract Details
Approval Date
7/3/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHESTER J. KUNNAPPILLY, CEO
(650) 573-2305
Contract Pharmacy Representative
Fair Oaks Community Pharmacy
Jennifer Kichinko, Pharmacist in Charge
(650) 480-6040
Signed By Date
7/3/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session