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WESTERN PHARMACY GROUP LLC
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
WESTERN PHARMACY GROUP LLC
Pharmacy Address
DBA GALLOWAY'S MEDICAL CENTER PHARMACY
2995 NATIONAL AVE
SAN DIEGO, CA 92113-2419
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ZARA MARSELIAN, CEO
(619) 584-1612 Ext: 3018
Contract Pharmacy Representative
Western Pharmacy Group LLC
David Wallace, Pharmacist
(619) 525-1551
Signed By Date
4/12/2018
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