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IMGRX SLO 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
IMGRX SLO INC
Pharmacy Address
DBA CHC PHARMACY PASO ROBLES
416 SPRING ST
PASO ROBLES, CA 93446
Pharmacy Comments
Contract Details
Approval Date
4/26/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/9/2019
Ownership change
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
Cardinal Health
Naveen Mansukhani, National Operations Director
(732) 328-0515
Signed By Date
4/26/2017
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