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MISSION PHARMACY
CH093190 TIBURCIO VASQUEZ HEALTH CENTER INCORPORATED
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Covered Entity Details
Entity Name
TIBURCIO VASQUEZ HEALTH CENTER INCORPORATED
Subdivision Name
TIBURCIO VASQUEZ HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH093190
Entity Address
33255 9th St
Union City, CA 94587-2137
Grant Number
H80CS00223
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
MISSION PHARMACY
Pharmacy Address
22138 MISSION BLVD
HAYWARD, CA 94541
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
David B. Vliet, CEO
(510) 690-6050
Contract Pharmacy Representative
New Oakland Pharmacy
Kam Tam, Outpatient Pharmacy Manager
(510) 428-3166
Signed By Date
4/15/2015
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