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WAL-MART PHARMACY 10-2291
CH09312BS 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
Diamond Neighborhoods Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH09312BS
Entity Address
4725 MARKET ST
SAN DIEGO, CA 92102-4715
Grant Number
H80CS00224
Participating Start Date
7/1/2008
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2291
Pharmacy Address
75 NORTH BROADWAY
CHULA VISTA (W), CA 91910
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
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/14/2019
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