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PIONEER MARKET 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
PIONEER MARKET PHARMACY
Pharmacy Address
5034 COAKLEY CIR STE 200
P.O. BOX 2128
MARIPOSA, CA 95338-8519
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
Pioneer Market Pharmacy
Carl Wood, Pharmacist
(209) 742-5552
Signed By Date
4/8/2024
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