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EL DORADO DRUG STORE
CH090780 Community Medical Centers, Inc.
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Covered Entity Details
Entity Name
Community Medical Centers, Inc.
Subdivision Name
Community Medical Centers, Channel
Type
HRSA-Funded Health Center
340B ID
CH090780
Entity Address
701 E Channel St.
Stockton, CA 95202-2628
Grant Number
H80CS00138
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
EL DORADO DRUG STORE
Pharmacy Address
2005 S MARIPOSA RD
STOCKTON, CA 95205
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/20/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christine Noguera, CEO
(209) 373-2826
Contract Pharmacy Representative
El Dorado Drug
JEFFERY BENNET, MANAGER
(209) 464-7722
Signed By Date
1/14/2019
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