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WESTERN PHARMACY GROUP LLC
CH0911100 SAN DIEGO FAMILY CARE
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Covered Entity Details
Entity Name
SAN DIEGO FAMILY CARE
Subdivision Name
LINDA VISTA HEALTH CARE CENTER
Type
HRSA-Funded Health Center
340B ID
CH0911100
Entity Address
6973 Linda Vista Rd
San Diego, CA 92111-6342
Grant Number
H80CS02319
Participating Start Date
4/1/1996
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
WESTERN PHARMACY GROUP LLC
Pharmacy Address
DBA MEDICAL CENTER PHARMACY
3904 PARK BLVD
SAN DIEGO, CA 92103-3502
Pharmacy Comments
Contract Details
Approval Date
4/2/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ROBERTA L. FEINBERG, CHIEF EXECUTIVE OFFICER
(858) 279-9676
Contract Pharmacy Representative
Western Pharmacy Group LLC
KEVIN FARIS, CEO
(360) 685-4263
Signed By Date
4/2/2018
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