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ELDAHMY WELLNESS PHARMACY INC.
CH091080 SAN YSIDRO HEALTH CENTER
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Covered Entity Details
Entity Name
SAN YSIDRO HEALTH CENTER
Subdivision Name
San Ysidro Health San Ysidro Health Center
Type
HRSA-Funded Health Center
340B ID
CH091080
Entity Address
4004 BEYER BLVD
San Ysidro, CA 92173
Grant Number
H80CS10748
Participating Start Date
12/1/1992
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
ELDAHMY WELLNESS PHARMACY INC.
Pharmacy Address
1985 NATIONAL AVE STE 1103
SAN DIEGO, CA 92113-2155
Pharmacy Comments
Contract Details
Approval Date
10/7/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Mattson, President & CEO
(619) 662-6322
Contract Pharmacy Representative
Eldahmy Wellness Pharmacy
Ahmed Eldahmy, Owner
(619) 331-1122
Signed By Date
10/7/2019
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