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CHULAVISTA PHARMACY LLC
CH09312C 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
Chula Vista Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH09312C
Entity Address
251 Landis Ave.
Chula Vista, CA 91910-2628
Grant Number
H80CS00224
Participating Start Date
7/1/2009
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
CHULAVISTA PHARMACY LLC
Pharmacy Address
384 H ST # 100
CHULA VISTA, CA 91910-5513
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
Chulavista Pharmacy
Elvis Atencio, 340B Rep.
(619) 781-8177
Signed By Date
10/14/2019
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