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MODERN HEALTH PHARMACY - SD
CH09108G 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 Children's Dental Center at Radys Children's Hospital
Type
HRSA-Funded Health Center
340B ID
CH09108G
Entity Address
8110 Birmingham Way
San Diego, CA 92123-4223
Grant Number
H80CS10748
Participating Start Date
7/1/2012
Last Recertification Date
2/24/2025
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
MODERN HEALTH PHARMACY - SD
Pharmacy Address
13220 EVENING CREEK DRIVE #109-110
SAN DIEGO, CA 92128
Pharmacy Comments
Contract Details
Approval Date
8/31/2012
Contract Begin Date
8/31/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
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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