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MEDICAL CENTER PHARMACY
CH095440 La Maestra Family Clinic, Inc.
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Covered Entity Details
Entity Name
La Maestra Family Clinic, Inc.
Subdivision Name
La Maestra Family clinic
Type
HRSA-Funded Health Center
340B ID
CH095440
Entity Address
4060 Fairmount Ave
San Diego, CA 92105-1608
Grant Number
H80CS00812
Participating Start Date
4/1/2000
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
3904 PARK BLVD
SAN DIEGO, CA 92103
Pharmacy Comments
Contract Details
Approval Date
10/15/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/18/2018
Ownership change
Contacts
Covered Entity Signing Official
ZARA MARSELIAN, CEO
(619) 584-1612 Ext: 3018
Contract Pharmacy Representative
Community Medical Center Pharmacy
Michelle Darnelle, Operations / Business Development Manager
(619) 206-0117
Signed By Date
10/15/2017
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