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ZIA PHARMACY
CH06301AD LA CLINICA DE FAMILIA INC,
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Covered Entity Details
Entity Name
LA CLINICA DE FAMILIA INC,
Subdivision Name
Central Medical Complex
Type
HRSA-Funded Health Center
340B ID
CH06301AD
Entity Address
575 S. Alameda
Las Cruces, NM 88005-2818
Grant Number
H80CS00316
Participating Start Date
1/1/2018
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
ZIA PHARMACY
Pharmacy Address
575 S ALAMEDA BLVD STE 102
LAS CRUCES, NM 88005-2818
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Virgil Medina, CEO
(575) 526-1105
Contract Pharmacy Representative
Zia Pharmacy
Joell Yan, Owner
(505) 639-5857
Signed By Date
1/11/2019
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