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MI FARMACIA SAN YSIDRO
STD92881 Planned Parenthood of the Pacific Southwest
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Covered Entity Details
Entity Name
Planned Parenthood of the Pacific Southwest
Subdivision Name
Corona
Type
Sexually Transmitted Diseases
340B ID
STD92881
Entity Address
2079 Compton Avenue
Suite 104
Corona, CA 92881
Grant Number
1H25PS005127
Participating Start Date
7/1/2019
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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