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FAMILY PHARMACY CENTER
CH091080 SAN YSIDRO HEALTH CENTER
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Covered Entity Details
Entity Name
SAN YSIDRO HEALTH CENTER
Subdivision Name
San Ysidro Health San Ysidro Health Center
Type
HRSA-Funded Health Center
340B ID
CH091080
Entity Address
4004 BEYER BLVD
San Ysidro, CA 92173
Grant Number
H80CS10748
Participating Start Date
12/1/1992
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY CENTER
Pharmacy Address
220 W MAIN ST STE 102
EL CAJON, CA 92020
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Wallace, VP of Finance & CFO
(619) 662-4100
Contract Pharmacy Representative
Family Pharmacy
Noor Mikhail, Pharmacist
(619) 334-2224
Signed By Date
7/8/2024
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