Contract Pharmacy Details

SMART PHARMACY #209
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

SMART PHARMACY #209

Pharmacy Address

610 WEST KETTLEMAN LANE
LODI, CA 95240

Pharmacy Comments

Contract Details

Approval Date

10/9/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/1/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kathleen Marshall, Acting CEO
(209) 373-2826

Contract Pharmacy Representative

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

Signed By Date

10/9/2013

340B Drug Pricing Program Database