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MEDICAL PAVILION PHARMACY
CH092535J SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC
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Covered Entity Details
Entity Name
SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC
Subdivision Name
Monterey Plaza Health Clinic
Type
HRSA-Funded Health Center
340B ID
CH092535J
Entity Address
5504 MONTEREY HWY
SAN JOSE, CA 95138-1529
Grant Number
H80CS06646
Participating Start Date
4/1/2016
Last Recertification Date
1/27/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
MEDICAL PAVILION PHARMACY
Pharmacy Address
9460 NO NAME UNO #100
GILROY, CA 95020-3536
Pharmacy Comments
Contract Details
Approval Date
7/13/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Salvador Chavarin, Chief Executive Officer
(408) 729-4290
Contract Pharmacy Representative
Haller
Henry Lim, Owner/Manager
(510) 793-5096
Signed By Date
7/13/2017
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