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MODERN HEALTH PHARMACY - SD
FP919111 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
Family Planning (Title X only)
340B ID
FP919111
Entity Address
1637 3rd Avenue
Suites H
Chula Vista, CA 91911
Grant Number
FPHPA096061
Participating Start Date
7/1/2012
Last Recertification Date
5/13/2024
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
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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