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GEN RX 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
GEN RX PHARMACY
Pharmacy Address
GEN RX
16800 LAKESHORE DR.
LAKE ELSINORE, CA 92530-4916
Pharmacy Comments
Contract Details
Approval Date
4/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Fernando Sanudo, CEO
(760) 631-5000 Ext: 4
Contract Pharmacy Representative
Gen Rx Pharmacy
Candice Malone, Manager
(805) 929-1929
Signed By Date
4/18/2016
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