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ISLAND INFUSION PHARMACY INC
CH02065H 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 Bayamon
Type
HRSA-Funded Health Center
340B ID
CH02065H
Entity Address
Carretera 167 Km 17.8 Barrio Pajaros Puertorriquenos
Bayamon, PR 00961-1477
Grant Number
H80CS00598
Participating Start Date
7/1/2019
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
ISLAND INFUSION PHARMACY INC
Pharmacy Address
ISLAND INFUSION PHARMACY
123 CALLE RODRIGO DE TRIANA
URB EL VEDADO
SAN JUAN, PR 00918
Pharmacy Comments
Contract Details
Approval Date
7/7/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gloria Del Carmen Amador, CEO
(787) 869-5900 Ext: 1111
Contract Pharmacy Representative
Island Infusion Pharmacy
Rafael Rivera, Administrator
(787) 393-0040
Signed By Date
7/7/2022
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