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INDIO MEDICAL PHARMACY
CHC28988-00 DAP HEALTH INC
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Covered Entity Details
Entity Name
DAP HEALTH INC
Subdivision Name
Desert AIDS Project, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC28988-00
Entity Address
1695 N Sunrise Way
Palm Springs, CA 92262-3701
Grant Number
H80CS28988
Participating Start Date
4/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
INDIO MEDICAL PHARMACY
Pharmacy Address
81-893 DR CARREON BLVD
STE 7
INDIO, CA 92201-5592
Pharmacy Comments
Contract Details
Approval Date
7/7/2022
Contract Begin Date
7/25/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/21/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Brinkman, Chief Executive Officer
(760) 992-0418
Contract Pharmacy Representative
Indio Medical Pharmacy
Wayne Kan, Pharmacist
(760) 347-0657
Signed By Date
7/7/2022
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