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FAIR OAKS COMMUNITY PHARMACY
CH09114D SAN MATEO MEDICAL CENTER
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Covered Entity Details
Entity Name
SAN MATEO MEDICAL CENTER
Subdivision Name
DALY CITY YOUTH HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH09114D
Entity Address
350 90th St
DALY CITY, CA 94015
Grant Number
H80CS00051
Participating Start Date
10/1/2001
Last Recertification Date
3/5/2025
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
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