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MEDICAL CENTER PHARMACY
CH09108A CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
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Covered Entity Details
Entity Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Subdivision Name
San Ysidro Health National City
Type
HRSA-Funded Health Center
340B ID
CH09108A
Entity Address
1136 D Ave
National City, CA 91950-3412
Grant Number
H80CS10748
Participating Start Date
4/1/1995
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
4074 FAIRMONT AVENUE
SAN DIEGO, CA 92105
Pharmacy Comments
Contract Details
Approval Date
6/14/2012
Contract Begin Date
6/14/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ed Martinez, President and CEO
(619) 428-4463
Contract Pharmacy Representative
George Awad, Pharmacy Director
(619) 997-4702
Signed By Date
4/28/2012
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