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AD-RX PHARMACY
CH091080 SAN YSIDRO HEALTH CENTER
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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
AD-RX PHARMACY
Pharmacy Address
6240 WILSHIRE BLVD.
LOS ANGELES, CA 90048
Pharmacy Comments
Contract Details
Approval Date
6/14/2012
Contract Begin Date
6/14/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/22/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ed Martinez, President and CEO
(619) 428-4463
Contract Pharmacy Representative
Sherri Cherman, President / Chief Operating Officer
(626) 932-1603
Signed By Date
4/27/2012
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