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SANTA MARIA PHARMACY
CHC31240-00 FIRST PERSON CARE CLINIC
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Covered Entity Details
Entity Name
FIRST PERSON CARE CLINIC
Subdivision Name
First Person Care Clinic
Type
HRSA-Funded Health Center
340B ID
CHC31240-00
Entity Address
1200 S 4TH ST
111
LAS VEGAS, NV 89104-1046
Grant Number
H80CS31240
Participating Start Date
4/1/2018
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
SANTA MARIA PHARMACY
Pharmacy Address
GUADALUPE PHARMACY INC
3827 E SUNSET RD STE L
LAS VEGAS, NV 89120-3900
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roxana Valeton, CEO
(305) 303-8108
Contract Pharmacy Representative
Santa Maria Pharmacy
Medhat Mansy, Pharmacist
(702) 474-0268
Signed By Date
4/15/2022
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