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MI FARMACIA SAN YSIDRO
CHC26623-00 OPERATION SAMAHAN, INC.
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Covered Entity Details
Entity Name
OPERATION SAMAHAN, INC.
Subdivision Name
OPSAM HEALTH: 2835 Highland
Type
HRSA-Funded Health Center
340B ID
CHC26623-00
Entity Address
2835 Highland Ave
National City, CA 91950-7412
Grant Number
H80CS26623
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MI FARMACIA SAN YSIDRO
Pharmacy Address
4630 BORDER VILLAGE RD STE K-L
SAN YSIDRO, CA 92173-3121
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/2/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Elidoro Primero, Executive Director
(844) 200-2426 Ext: 1071
Contract Pharmacy Representative
Hillcrest Pharmacy
Susan Baeza, Owner
(619) 260-1010
Signed By Date
1/15/2020
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