Contract Pharmacy Details

TRUEPILL NY LLC
CH091080 SAN YSIDRO HEALTH CENTER

Covered Entity Details

Entity Name

SAN YSIDRO HEALTH CENTER

Subdivision Name

San Ysidro Health San Ysidro Health Center

Type

HRSA-Funded Health Center

340B ID

CH091080

Entity Address

4004 BEYER BLVD
San Ysidro, CA 92173

Grant Number

H80CS10748

Participating Start Date

12/1/1992

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

TRUEPILL NY LLC

Pharmacy Address

850 3RD AVE STE 404
BROOKLYN, NY 11232-1523

Pharmacy Comments

Contract Details

Approval Date

10/14/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kevin Mattson, President & CEO
(619) 662-6322

Contract Pharmacy Representative

Truepill
Joshua Reiter, PIC
(518) 692-3362

Signed By Date

10/14/2021