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MEDICAL PAVILION PHARMACY
CH09122P BAY AREA COMMUNITY HEALTH
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Covered Entity Details
Entity Name
BAY AREA COMMUNITY HEALTH
Subdivision Name
Monterey Plaza Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH09122P
Entity Address
5504 Monterey Hwy
San Jose, CA 95138-1529
Grant Number
H80CS02326
Participating Start Date
10/1/2020
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
MEDICAL PAVILION PHARMACY
Pharmacy Address
9460 NO NAME UNO #100
GILROY, CA 95020-3536
Pharmacy Comments
Contract Details
Approval Date
8/27/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/21/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Zettie D Page, CEO
(760) 902-5249
Contract Pharmacy Representative
Alisal Pharmacy
Jasmine Sonita Basrai, President
(310) 463-3682
Signed By Date
8/27/2020
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