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MEDICAL CENTER PHARMACY AT FATHER JOE'S
CH09312BU FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
Subdivision Name
FHCSD Mobile Medical Unit III
Type
HRSA-Funded Health Center
340B ID
CH09312BU
Entity Address
823 Gateway Center Way
San Diego, CA 92102-4541
Grant Number
H80CS00224
Participating Start Date
1/1/2011
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY AT FATHER JOE'S
Pharmacy Address
CONDUCTED BY MCP/SVDPV LLC
16 15TH STREET
SAN DIEGO, CA 92101
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ricardo Roman, CFO
(619) 906-4603
Contract Pharmacy Representative
Western Pharmacy Group LLC
KEVIN FARIS, CEO
(360) 685-4263
Signed By Date
10/14/2019
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