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EVERGREEN RX PHARMACY INC
CH093540 NEIGHBORHOOD HEALTHCARE
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Covered Entity Details
Entity Name
NEIGHBORHOOD HEALTHCARE
Subdivision Name
RAY M. DICKINSON WELLNESS CENTER
Type
HRSA-Funded Health Center
340B ID
CH093540
Entity Address
425 N. DATE ST
ESCONDIDO, CA 92025-3413
Grant Number
H80CS00285
Participating Start Date
4/1/1996
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
EVERGREEN RX PHARMACY INC
Pharmacy Address
DBA EVERGREEN RX PHARMACY
40963 WINCHESTER RD
TEMECULA, CA 92591
Pharmacy Comments
Contract Details
Approval Date
10/12/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TRACY REAM, CEO
(760) 520-8375
Contract Pharmacy Representative
Lam Trinh, Owner
(951) 296-9074
Signed By Date
10/12/2016
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