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MISSION PARK PHARMACY
CH091670 VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
VCC: VALE TERRACE
Type
HRSA-Funded Health Center
340B ID
CH091670
Entity Address
1000 Vale Terrace Dr.
Vista, CA 92084-5218
Grant Number
H80CS00282
Participating Start Date
4/1/1996
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MISSION PARK PHARMACY
Pharmacy Address
2201 MISSION AVE
OCEANSIDE, CA 92058
Pharmacy Comments
Contract Details
Approval Date
7/10/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/17/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Fernando Sanudo, CEO
(760) 631-5000 Ext: 4
Contract Pharmacy Representative
Christina Ka, Pharmacy Manager
(760) 757-1212
Signed By Date
7/10/2014
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