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MEDICAL PAVILION PHARMACY
CH091220 BAY AREA COMMUNITY HEALTH
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Covered Entity Details
Entity Name
BAY AREA COMMUNITY HEALTH
Subdivision Name
Mowry I Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH091220
Entity Address
2299 MOWRY AVE STE 3B
FREMONT, CA 94538-1621
Grant Number
H80CS02326
Participating Start Date
7/1/1996
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
MEDICAL PAVILION PHARMACY
Pharmacy Address
9460 N NAME UNO STE 100
GILROY, CA 95020-3536
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zettie D Page, CEO
(760) 902-5249
Contract Pharmacy Representative
Alisal Pharmacy
Jasmine Sonita Basrai, President
(310) 463-3682
Signed By Date
7/12/2022
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