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HILLCREST 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
HILLCREST PHARMACY
Pharmacy Address
120 UNIVERSITY AVE
SAN DIEGO, CA 92103
Pharmacy Comments
Contract Details
Approval Date
6/27/2012
Contract Begin Date
6/27/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gilbert Fimbres, CFO
(619) 662-6331
Contract Pharmacy Representative
Hillcrest Pharmacy
Susan Baeza, Owner
(619) 260-1010
Signed By Date
7/13/2012
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