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IMGRX SLO, INC. DBA
CH09071AV 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 - SAN MIGUEL
Type
HRSA-Funded Health Center
340B ID
CH09071AV
Entity Address
1385 Mission St
San Miguel, CA 93451
Grant Number
H80CS00621
Participating Start Date
10/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
IMGRX SLO, INC. DBA
Pharmacy Address
CHC PHARMACY PASO ROBLES
2800 RIVERSIDE AVENUE
SUITE 150
PASO ROBLES, CA 93446
Pharmacy Comments
Contract Details
Approval Date
5/5/2023
Contract Begin Date
5/8/2023
Carve-In Effective Date
Contract Comments
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
5/5/2023
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