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AD-RX PHARMACY
CH09108L CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
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Covered Entity Details
Entity Name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Subdivision Name
San Ysidro Health Otay
Type
HRSA-Funded Health Center
340B ID
CH09108L
Entity Address
1637 3RD AVE STE BF
CHULA VISTA, CA 91911-5823
Grant Number
H80CS10748
Participating Start Date
7/1/2012
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
AD-RX PHARMACY
Pharmacy Address
6240 WILSHIRE BLVD.
LOS ANGELES, CA 90048
Pharmacy Comments
Contract Details
Approval Date
8/31/2012
Contract Begin Date
8/31/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ed Martinez, President and CEO
(619) 428-4463
Contract Pharmacy Representative
Sherri Cherman, President / Chief Operating Officer
(626) 932-1603
Signed By Date
8/10/2012
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