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LUCKY PHARMACY #768
CH091220 BAY AREA COMMUNITY HEALTH
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Covered Entity Details
Entity Name
BAY AREA COMMUNITY HEALTH
Subdivision Name
Mowry I Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH091220
Entity Address
2299 MOWRY AVE STE 3B
FREMONT, CA 94538-1621
Grant Number
H80CS02326
Participating Start Date
7/1/1996
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
LUCKY PHARMACY #768
Pharmacy Address
15840 HESPERIAN BLVD
SAN LORENZO, CA 94580
Pharmacy Comments
Contract Details
Approval Date
1/9/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Ownership change
Contacts
Covered Entity Signing Official
Zettie D Page, CEO
(760) 902-5249
Contract Pharmacy Representative
Save Mart Supermarkets
Robert Vaughan, Executive Director, Pharmacy
(209) 574-6299
Signed By Date
1/9/2017
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