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WAL-MART PHARMACY 10-5638
CH093120 FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
Subdivision Name
Logan Heights Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH093120
Entity Address
1809 National Ave
San Diego, CA 92113-2113
Grant Number
H80CS00224
Participating Start Date
12/1/1992
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5638
Pharmacy Address
2121 IMPERIAL AVE
SAN DIEGO, CA 92102
Pharmacy Comments
Contract Details
Approval Date
1/9/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Ricardo Roman, CFO
(619) 906-4603
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/9/2014
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