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WAL-MART PHARMACY 10-2150
CHC26623-00 OPERATION SAMAHAN, INC.
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Covered Entity Details
Entity Name
OPERATION SAMAHAN, INC.
Subdivision Name
OPSAM HEALTH: 2835 Highland
Type
HRSA-Funded Health Center
340B ID
CHC26623-00
Entity Address
2835 Highland Ave
National City, CA 91950-7412
Grant Number
H80CS26623
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2150
Pharmacy Address
710 DENNERY RD
SAN DIEGO, CA 92154
Pharmacy Comments
12/31/2012 zip update (was 92173)
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/26/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dirk Darwin Zirbel, CEO
(310) 699-0998
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/17/2017
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