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NIPOMO PHARMACY INC
CH090710 COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
Subdivision Name
NIPOMO COMMUNITY MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH090710
Entity Address
150 TEJAS PL
NIPOMO, CA 93444-9123
Grant Number
H80CS00621
Participating Start Date
4/1/1996
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
NIPOMO PHARMACY INC
Pharmacy Address
DBA NIPOMO REXALL DRUGS
695 W TEFFT ST STE A
NIPOMO, CA 93444-9395
Pharmacy Comments
1/22/10 - CHANGED STREET ADDRESS FROM 330 E TEFFT ST TO CORRECT TYPO.
Contract Details
Approval Date
10/3/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/28/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
Nipomo Rexall Pharmacy
Jessica Mashayekhan, Manager
(805) 929-1929
Signed By Date
10/3/2016
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