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GEN RX PHARMACY
CH09167K VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
Mobile Dental Clinic 2
Type
HRSA-Funded Health Center
340B ID
CH09167K
Entity Address
30195 Fraser Drive
Lake Elsinore, CA 92530-7006
Grant Number
H80CS00282
Participating Start Date
10/1/2017
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
GEN RX PHARMACY
Pharmacy Address
GEN RX
16800 LAKESHORE DR.
LAKE ELSINORE, CA 92530-4916
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele Lambert, CFO
(760) 216-5803
Contract Pharmacy Representative
Gen Rx Pharmacy
Candice Malone, Manager
(805) 929-1929
Signed By Date
7/12/2023
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