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WAL-MART PHARMACY 10-2253
CH09312BW FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
Subdivision Name
Teen Health Center
Type
HRSA-Funded Health Center
340B ID
CH09312BW
Entity Address
1643 Logan Ave
San Diego, CA 92113-1004
Grant Number
H80CS00224
Participating Start Date
1/1/2011
Last Recertification Date
2/18/2019
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2253
Pharmacy Address
13487 CAMINO CANADA
EL CAJON (EAST), CA 92021
Pharmacy Comments
Contract Details
Approval Date
9/27/2012
Contract Begin Date
9/27/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Fran Butler-Cohen, CEO
(619) 515-2301
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
9/7/2012
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