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MAXOR SPECIALTY PHARMACY
FQHCLA420 COMMUNITY HEALTH CENTERS OF AMERICA
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF AMERICA
Subdivision Name
CHCA Mariposa
Type
Health Center Program Look-Alike
340B ID
FQHCLA420
Entity Address
5320 State Highway 49 N Ste 1
Mariposa, CA 95338-9588
Grant Number
LALCS40180
Participating Start Date
7/1/2024
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
MAXOR SPECIALTY PHARMACY
Pharmacy Address
150 CLEVELAND RD
SUITE B
BOGART, GA 30622-1701
Pharmacy Comments
Contract Details
Approval Date
6/14/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Naresh Channaveerappa, CEO
(209) 678-0990
Contract Pharmacy Representative
Maxor National Pharmacy Services
Ronald Sosa, Regional Patient Care Advocate
(863) 558-5736
Signed By Date
4/8/2024
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