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IMGRX SLO, INC. DBA
CH09071AY Community Health Centers Of The Central Coast, Inc.
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Covered Entity Details
Entity Name
Community Health Centers Of The Central Coast, Inc.
Subdivision Name
COMMUNITY HEALTH CENTERS COASTAL DENTAL
Type
HRSA-Funded Health Center
340B ID
CH09071AY
Entity Address
1304 South Miller St.
Santa Maria, CA 93454
Grant Number
H80CS00621
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
IMGRX SLO, INC. DBA
Pharmacy Address
CHC PHARMACY SLO
77 CASA STREET, SUITE 205
SAN LUIS OBISPO, CA 93405
Pharmacy Comments
Contract Details
Approval Date
5/4/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/5/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
Cardinal Health
Naveen Mansukhani, National Operations Director
(732) 328-0515
Signed By Date
5/4/2023
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