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CHILDREN'S HOMECARE PHARMACY
HM92123 RADY CHILDRENS HOSPITAL - SAN DIEGO
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Covered Entity Details
Entity Name
RADY CHILDRENS HOSPITAL - SAN DIEGO
Subdivision Name
HEMOPHILIA TREATMENT CENTER
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM92123
Entity Address
3020 CHILDRENS WAY
SAN DIEGO, CA 92123
Grant Number
H30MC24045
Participating Start Date
7/1/2002
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
CHILDREN'S HOMECARE PHARMACY
Pharmacy Address
RADY CHILDREN'S HOMECARE PHARMACY
8291 AERO PLACE STE 130 140 150
SAN DIEGO, CA 92123
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
Nicholas Matthew Holmes, Senior VP, Chief Operating Officer
(858) 966-5948
Contract Pharmacy Representative
Rady Childrens Hospital
Mark Sey, Pharmicist in Chief
(858) 966-8023
Signed By Date
4/12/2018
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