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KMART PHARMACY
CH099010 BORREGO COMMUNITY HEALTH FOUNDATION
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Covered Entity Details
Entity Name
BORREGO COMMUNITY HEALTH FOUNDATION
Subdivision Name
BORREGO COMMUNITY HEALTH FOUNDATION
Type
HRSA-Funded Health Center
340B ID
CH099010
Entity Address
4343 YAQUI PASS ROAD
BORREGO SPRINGS, CA 92004-2369
Grant Number
H80CS00287
Participating Start Date
1/1/2003
Last Recertification Date
2/13/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
KMART PHARMACY
Pharmacy Address
26471 YNEZ ROAD
TEMECULA, CA 92591
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/2/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
BRUCE HEBETS, CEO
(760) 767-6433
Contract Pharmacy Representative
Sears
Jennifer Speares, Director of Administration and Compliance
(847) 286-5116
Signed By Date
7/15/2016
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