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AG PHARMACY
CH09107BQ San Francisco Community Clinic Consortium
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Covered Entity Details
Entity Name
San Francisco Community Clinic Consortium
Subdivision Name
CHPY-Larkin Street Youth Center
Type
HRSA-Funded Health Center
340B ID
CH09107BQ
Entity Address
Larkin Street Clinic
134 Golden Gate Avenue
San Francisco, CA 94102
Grant Number
H80CS00049
Participating Start Date
7/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AG PHARMACY
Pharmacy Address
3636 CESAR CHAVEZ
SAN FRANCISCO, CA 94110
Pharmacy Comments
Contract Details
Approval Date
10/17/2012
Contract Begin Date
10/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael Baxter, Director of Youth Programs (COPC) and Family Planning (MCAH)
(415) 575-5685
Contract Pharmacy Representative
Vivian Cheung, Pharmacy Manager
(415) 657-3757
Signed By Date
9/18/2012
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