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WESTERN PHARMACY GROUP LLC
CH09312DA 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
North Park Family Health Center II
Type
HRSA-Funded Health Center
340B ID
CH09312DA
Entity Address
3514 30th St
San Diego, CA 92104-4120
Grant Number
H80CS00224
Participating Start Date
10/1/2016
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
WESTERN PHARMACY GROUP LLC
Pharmacy Address
DBA GALLOWAY'S MEDICAL CENTER PHARMACY
2995 NATIONAL AVE
SAN DIEGO, CA 92113-2419
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
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
David Wallace, Pharmacist
(619) 525-1551
Signed By Date
10/15/2019
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