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MEDICAL CENTER PHARMACY
CH0911100 SAN DIEGO FAMILY CARE
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Covered Entity Details
Entity Name
SAN DIEGO FAMILY CARE
Subdivision Name
LINDA VISTA HEALTH CARE CENTER
Type
HRSA-Funded Health Center
340B ID
CH0911100
Entity Address
6973 Linda Vista Rd
San Diego, CA 92111-6342
Grant Number
H80CS02319
Participating Start Date
4/1/1996
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
4074 FAIRMONT AVENUE
SAN DIEGO, CA 92105
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/28/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
ROBERTA L. FEINBERG, CHIEF EXECUTIVE OFFICER
(858) 279-9676
Contract Pharmacy Representative
George Awad, Pharmacy Director
(619) 997-4702
Signed By Date
4/12/2013
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