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COMMUNITY MEDICAL PHARMACY
CH091520 MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
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Covered Entity Details
Entity Name
MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Subdivision Name
Mountain Empire Family Medicine
Type
HRSA-Funded Health Center
340B ID
CH091520
Entity Address
31115 HIGHWAY 94
Campo, CA 91906-3133
Grant Number
H80CS00284
Participating Start Date
10/1/2002
Last Recertification Date
2/7/2020
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
COMMUNITY MEDICAL PHARMACY
Pharmacy Address
IN-HOUSE PHARMACIES, INC.
610 GATEWAY CENTER WAY NO. A
SAN DIEGO, CA 92102-4548
Pharmacy Comments
Contract Details
Approval Date
8/29/2012
Contract Begin Date
8/29/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Judith Shaplin, CEO
(619) 445-6200
Contract Pharmacy Representative
George Awad, Pharmacy Director
(619) 997-4702
Signed By Date
7/26/2012
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