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AG PHARMACY
CH09107L SF COMMUNITY CLINIC CONSORTIUM
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Covered Entity Details
Entity Name
SF COMMUNITY CLINIC CONSORTIUM
Subdivision Name
ADULT MEDICINE CLINICS-WARD 86
Type
HRSA-Funded Health Center
340B ID
CH09107L
Entity Address
995 POTRERO AVE, BLDG 80, 6TH FL
WARD 86
SAN FRANCISCO, CA 94110
Grant Number
H80CS00049
Participating Start Date
4/1/2003
Last Recertification Date
2/13/2017
Entity Termination Date
7/1/2017
Pharmacy Details
Pharmacy Name
AG PHARMACY
Pharmacy Address
3636 CESAR CHAVEZ
SAN FRANCISCO, CA 94110
Pharmacy Comments
Contract Details
Approval Date
3/1/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Susan Currin, Chief Executive Officer
(415) 206-3517
Contract Pharmacy Representative
Vivian Cheung, Pharmacy Manager
(415) 657-3757
Signed By Date
1/10/2013
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