Contract Pharmacy Details

DMK PHARMACY
CH091520 MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.

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

DMK PHARMACY

Pharmacy Address

1730 ALPINE BLVD STE 109
ALPINE, CA 91901-3877

Pharmacy Comments

Contract Details

Approval Date

4/11/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Amy Weisiger, CFO
(619) 478-5254 Ext: 229

Contract Pharmacy Representative

Martin Gorence, owner
(619) 561-5602

Signed By Date

4/11/2016