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MEDICAL CENTER PHARMACY
CH0933070 ST. VINCENT DE PAUL VILLAGE, INC.
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Covered Entity Details
Entity Name
ST. VINCENT DE PAUL VILLAGE, INC.
Subdivision Name
Village Health Center
Type
HRSA-Funded Health Center
340B ID
CH0933070
Entity Address
16 15th St
San Diego, CA 92101
Grant Number
H80CS10606
Participating Start Date
9/5/2008
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
4074 FAIRMONT AVENUE
SAN DIEGO, CA 92105
Pharmacy Comments
Contract Details
Approval Date
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jeffrey Norris, CMO
(619) 645-6422
Contract Pharmacy Representative
Community Medical Center Pharmacy
Michelle Darnelle, Operations / Business Development Manager
(619) 206-0117
Signed By Date
1/3/2019
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