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FQHCLA338 HORISONS UNLIMITED (Terminated)
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Main Details
Name
HORISONS UNLIMITED
Subdivision Name
Horisons Unlimited Mariposa
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-014844
340B ID
FQHCLA338
Grant Number
LALCS00172
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/30/2015
Last Recertification Date
1/27/2017
Termination Date
Termination Reason
10/12/2017
Loss of qualifying grant/support
Contacts
Authorizing Official
Joy Raron, CQO
(209) 383-5200
Primary Contact
Joy Raron, CQO
(209) 383-5200
Addresses
Street Address
5320 STATE HIGHWAY 49 N
MARIPOSA, CA 95338-9588
Billing Address
Horisons Unlimited
5594 N. G St
Merced, CA 95340
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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