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MODERN HEALTH PHARMACY - SD
CH09108C 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 Euclid
Type
HRSA-Funded Health Center
340B ID
CH09108C
Entity Address
286 Euclid Ave STE 302
San Diego, CA 92114-3613
Grant Number
H80CS10748
Participating Start Date
4/1/2009
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
MODERN HEALTH PHARMACY - SD
Pharmacy Address
13220 EVENING CREEK DRIVE #109-110
SAN DIEGO, CA 92128
Pharmacy Comments
Contract Details
Approval Date
6/14/2012
Contract Begin Date
6/14/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ed Martinez, President and CEO
(619) 428-4463
Contract Pharmacy Representative
Sherri Cherman, President / Chief Operating Officer
(626) 932-1603
Signed By Date
4/27/2012
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