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SANTA MARIA PHARMACY INC
CHC28370-04 Tri-State Community Healthcare Center
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Covered Entity Details
Entity Name
Tri-State Community Healthcare Center
Subdivision Name
Tri-State Community Healthcare Center- Mobile Unit
Type
HRSA-Funded Health Center
340B ID
CHC28370-04
Entity Address
11888 Bartlett Ave
Adelanto, CA 92301-1709
Grant Number
H80CS28370
Participating Start Date
4/1/2020
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
SANTA MARIA PHARMACY INC
Pharmacy Address
DBA SANTA MARIA COMMUNITY PHARMACY
11004 VALLEY MALL
EL MONTE, CA 91731
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Aram Manoukian, CEO
(760) 326-0222 Ext: 8186584000
Contract Pharmacy Representative
PHARMACY
MARCOS SOLIMAN, OWNER
(714) 556-7788
Signed By Date
4/13/2020
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