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MI FARMACIA SAN YSIDRO
STD921261 Planned Parenthood of the Pacific Southwest
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Covered Entity Details
Entity Name
Planned Parenthood of the Pacific Southwest
Subdivision Name
Mira Mesa
Type
Sexually Transmitted Diseases
340B ID
STD921261
Entity Address
10717 Camino Ruiz
Suite #258
San Diego, CA 92126
Grant Number
1H25PS005127
Participating Start Date
1/1/2016
Last Recertification Date
5/12/2025
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
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/6/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Darrah Johnson, CEO
(619) 881-5050 Ext: 6198815050
Contract Pharmacy Representative
AIDS HEALTHCARE FOUNDATION
Peter Reis, Senior Vice President
(323) 860-5208
Signed By Date
1/14/2021
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