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SAN JOAQUIN GEN HOSP
FQHCLA328C SAN JOAQUIN, COUNTY OF
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Covered Entity Details
Entity Name
SAN JOAQUIN, COUNTY OF
Subdivision Name
Family Practice Clinic California
Type
Health Center Program Look-Alike
340B ID
FQHCLA328C
Entity Address
1414 N CALIFORNIA ST
Suite C
STOCKTON, CA 95202-1515
Grant Number
LALCS00158
Participating Start Date
10/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SAN JOAQUIN GEN HOSP
Pharmacy Address
500 W HOSPITAL RD
FRENCH CAMP, CA 95231
Pharmacy Comments
Contract Details
Approval Date
10/6/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Samantha Phillips-Bland, Executive Director
(209) 468-6160
Contract Pharmacy Representative
Ross Bauman, Pharmacy Supervisor
(209) 468-7225
Signed By Date
10/6/2014
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