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SAN JOAQUIN GEN HOSP
STD95201 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES
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Covered Entity Details
Entity Name
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD95201
Entity Address
1601 E HAZELTON AVE
STOCKTON, CA 95205
Grant Number
1H25PS005127
Participating Start Date
4/1/2009
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
SAN JOAQUIN GEN HOSP
Pharmacy Address
500 W HOSPITAL RD
FRENCH CAMP, CA 95231
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Evans, Director
(209) 468-3410
Contract Pharmacy Representative
San Joaquin General Hospital
Krissy Hirai, ACS Pharmacy Supervisor
(209) 468-7225
Signed By Date
4/13/2015
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