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PIONEER MARKET PHARMACY
FQHC638480 MACT Health Board, Inc.
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Covered Entity Details
Entity Name
MACT Health Board, Inc.
Subdivision Name
MACT Medical, Sonora
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638480
Entity Address
13975 MONO WAY
SUITE G,H, I, J
SONORA, CA 95370
Grant Number
Participating Start Date
1/1/2003
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
PIONEER MARKET PHARMACY
Pharmacy Address
5034 COAKLEY CIR STE 200
P.O. BOX 2128
MARIPOSA, CA 95338-8519
Pharmacy Comments
Contract Details
Approval Date
1/11/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Shawver Alexander, Executive Director
(209) 754-6258
Contract Pharmacy Representative
Carl Wood, Pharmacist
(209) 742-5550
Signed By Date
1/11/2016
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