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FARMACIA COOPERATIVA SAN MIGUEL INC
CH02065A SALUD INTEGRAL EN LA MONTANA INC
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Covered Entity Details
Entity Name
SALUD INTEGRAL EN LA MONTANA INC
Subdivision Name
Centro de Salud Integral en Naranjito
Type
HRSA-Funded Health Center
340B ID
CH02065A
Entity Address
Carr. 164 Km. 0.2
Bo. Achiote, Sector El Desvio
Naranjito, PR 00719
Grant Number
H80CS00598
Participating Start Date
10/1/1996
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
FARMACIA COOPERATIVA SAN MIGUEL INC
Pharmacy Address
FARMACIA COOPERATIVA SAN MIGUEL
CARR 152 KM 17.8 BO CEDRO ABAJO
C/O P O BOX 459
NARANJITO, PR 00719
Pharmacy Comments
Contract Details
Approval Date
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gloria Amador, CEO
(787) 869-5900
Contract Pharmacy Representative
Farmacia Coop San Miguel
Aurea Nieves, Pharmacist
(787) 869-4710
Signed By Date
10/9/2019
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