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WAL-MART PHARMACY 10-5315
CH09312CU 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
Logan Heights Patient Care Support Services
Type
HRSA-Funded Health Center
340B ID
CH09312CU
Entity Address
1827 Logan Ave STE 2
San Diego, CA 92113-2137
Grant Number
H80CS00224
Participating Start Date
10/1/2016
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
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
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/15/2019
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