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WAL-MART PHARMACY 10-2291
CH09312AW 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 Counseling Center
Type
HRSA-Funded Health Center
340B ID
CH09312AW
Entity Address
2204 National Ave
San Diego, CA 92113-3615
Grant Number
H80CS00224
Participating Start Date
7/1/2008
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2291
Pharmacy Address
75 NORTH BROADWAY
CHULA VISTA (W), CA 91910
Pharmacy Comments
Contract Details
Approval Date
9/27/2012
Contract Begin Date
9/27/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Fran Butler-Cohen, CEO
(619) 515-2301
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/7/2012
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