Contract Pharmacy Details

HILLCREST PHARMACY
RWI921010 Christie's Place, Inc.

Covered Entity Details

Entity Name

Christie's Place, Inc.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI921010

Entity Address

2440 Third Avenue
San Diego, CA 92101

Grant Number

H89HA00001

Participating Start Date

4/1/2020

Last Recertification Date

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

HILLCREST PHARMACY

Pharmacy Address

120 UNIVERSITY AVE
SAN DIEGO, CA 92103

Pharmacy Comments

Contract Details

Approval Date

3/10/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Rhea Van Brocklin, Executive Director
(619) 702-4186 Ext: 6197024186

Contract Pharmacy Representative

Hillcrest Pharmacy
Susan Baeza, Owner
(619) 260-1010

Signed By Date

3/10/2020

340B Drug Pricing Program Database