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TED'S VILLAGE PHARMACY INC
TB944037 SAN MATEO COUNTY HEALTH SERVICES
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Covered Entity Details
Entity Name
SAN MATEO COUNTY HEALTH SERVICES
Subdivision Name
Public Health, Policy and Planning, TB Control
Type
Tuberculosis
340B ID
TB944037
Entity Address
225 WEST 37TH AVENUE
C/o PHPP TB Control Program
Building A, Floor 2
SAN MATEO, CA 94403
Grant Number
5NU52PS910219
Participating Start Date
7/1/1996
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
TED'S VILLAGE PHARMACY INC
Pharmacy Address
29 W 25TH AVE
SAN MATEO, CA 94403-2236
Pharmacy Comments
Contract Details
Approval Date
4/17/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Morrow, Agency Medical Director, Health Officer
(650) 573-2519
Contract Pharmacy Representative
Signed By Date
4/17/2015
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