Contract Pharmacy Details

ANCHOR DRUGS
DSH050113 SAN MATEO MEDICAL CENTER

Covered Entity Details

Entity Name

SAN MATEO MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050113

Entity Address

222 WEST 39TH AVENUE
SAN MATEO, CA 94403

Medicare Provider Number

050113

Participating Start Date

1/1/2005

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

ANCHOR DRUGS

Pharmacy Address

161 S SPRUCE AVE
SOUTH SAN FRANCISCO, CA 94080

Pharmacy Comments

Contract Details

Approval Date

4/15/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

SUSAN EHRLICH, CEO
(650) 573-2041

Contract Pharmacy Representative

Raymond Jajeh, President
(650) 360-5300

Signed By Date

4/15/2015