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MCC PHARMACY
CH09538B MARIN COMMUNITY CLINIC
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Covered Entity Details
Entity Name
MARIN COMMUNITY CLINIC
Subdivision Name
Marin Community Clinic - San Rafael
Type
HRSA-Funded Health Center
340B ID
CH09538B
Entity Address
3110 KERNER BLVD
SAN RAFAEL, CA 94901
Grant Number
H80CS00343
Participating Start Date
1/1/2010
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MCC PHARMACY
Pharmacy Address
3110 KERNER BLVD
SAN RAFAEL, CA 94901
Pharmacy Comments
Contract Details
Approval Date
2/14/2012
Contract Begin Date
2/14/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/28/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
pat iantorno, pharmacy mgr
(858) 245-7177
Contract Pharmacy Representative
Paul Lofholm, Secretary
(415) 845-6160
Signed By Date
2/1/2012
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