Contract Pharmacy Details

LUCKY PHARMACY #783
CH090780 Community Medical Centers, Inc.

Covered Entity Details

Entity Name

Community Medical Centers, Inc.

Subdivision Name

Community Medical Centers, Channel

Type

HRSA-Funded Health Center

340B ID

CH090780

Entity Address

701 E Channel St.
Stockton, CA 95202-2628

Grant Number

H80CS00138

Participating Start Date

12/1/1992

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

LUCKY PHARMACY #783

Pharmacy Address

777 E. MONTE VISTA AVE
VACAVILLE, CA 95688

Pharmacy Comments

Contract Details

Approval Date

6/29/2012

Contract Begin Date

7/5/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/19/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

DAVID JOMAOAS, COO
(209) 373-2832

Contract Pharmacy Representative

Robert Vaughan, Senior Director of Pharmacy Operations
(209) 574-6220

Signed By Date

6/29/2012

340B Drug Pricing Program Database