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WESTERN PHARMACY GROUP LLC
CH093120 FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF SAN DIEGO, INC.
Subdivision Name
Logan Heights Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH093120
Entity Address
1809 National Ave
San Diego, CA 92113-2113
Grant Number
H80CS00224
Participating Start Date
12/1/1992
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
WESTERN PHARMACY GROUP LLC
Pharmacy Address
DBA MEDICAL CENTER PHARMACY
4074 FAIRMOUNT AVE
SAN DIEGO, CA 92105-1608
Pharmacy Comments
Contract Details
Approval Date
3/7/2018
Contract Begin Date
3/9/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/20/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Ricardo Roman, CFO
(619) 906-4603
Contract Pharmacy Representative
Western Pharmacy Group
Steve Fazziola, Pharmacist
(619) 284-1141
Signed By Date
3/7/2018
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