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MEDICAL CENTER PHARMACY LTC
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
MEDICAL CENTER PHARMACY LTC
Pharmacy Address
CONDUCTED BY WESTERN PHARMACY GROUP LLC
610 GATEWAY CENTER WAY STE H-I
SAN DIEGO, CA 92102-4533
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mikia Wallis, Chief Executive Officer
(760) 767-6641
Contract Pharmacy Representative
Western Pharmacy Group LLC
KEVIN FARIS, CEO
(360) 685-4263
Signed By Date
4/15/2020
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