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KMART PHARMACY #4705
CH090560 UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
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Covered Entity Details
Entity Name
UNITED HEALTH CENTERS OF THE SAN JOAQUIN VALLEY
Subdivision Name
UNITED HEALTH CENTERS PARLIER
Type
HRSA-Funded Health Center
340B ID
CH090560
Entity Address
650 S Zediker Ave
Parlier, CA 93648-2639
Grant Number
H80CS00137
Participating Start Date
12/1/1992
Last Recertification Date
2/24/2021
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
KMART PHARMACY #4705
Pharmacy Address
333 SIERRA
KINGSBURG, CA 93631
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/2/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
COLLEEN CURTIS, CEO
(559) 646-6618 Ext: 0007
Contract Pharmacy Representative
Kmart
Jennifer Speares, Director Administration/Compliance
(904) 783-5183
Signed By Date
10/17/2016
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