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SAN MATEO NEIGHBORHOOD PHARMACY
CH091140 SAN MATEO, COUNTY OF
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Covered Entity Details
Entity Name
SAN MATEO, COUNTY OF
Subdivision Name
39th Outpatient Clinics
Type
HRSA-Funded Health Center
340B ID
CH091140
Entity Address
222 W 39th Ave
San Mateo, CA 94403-4364
Grant Number
H80CS00051
Participating Start Date
10/1/2001
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
SAN MATEO NEIGHBORHOOD PHARMACY
Pharmacy Address
9 37TH AVENUE
SAN MATEO, CA 94403
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHESTER J. KUNNAPPILLY, CEO
(650) 573-2305
Contract Pharmacy Representative
Alvin Lee, Owner
(650) 827-5277
Signed By Date
7/15/2016
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