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MEDICAL CENTER 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
MEDICAL CENTER PHARMACY
Pharmacy Address
PARK MEDICAL PHARMACY
480 4TH AVE STE 100
CHULA VISTA, CA 91910
Pharmacy Comments
Contract Details
Approval Date
6/15/2012
Contract Begin Date
6/15/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Ownership change
Contacts
Covered Entity Signing Official
Ed Martinez, President and CEO
(619) 428-4463
Contract Pharmacy Representative
George Awad, Pharmacy Director
(619) 997-4702
Signed By Date
4/28/2012
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