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ISLAND INFUSION PHARMACY INC
CH021030 Costa Salud Community Health Centers, Inc
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Covered Entity Details
Entity Name
Costa Salud Community Health Centers, Inc
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH021030
Entity Address
28 Calle Munoz Rivera W
Rincon, PR 00677-2127
Grant Number
H80CS00356
Participating Start Date
10/1/1996
Last Recertification Date
2/11/2025
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
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susana M. Perez, Executive Director
(787) 823-5555 Ext: 180
Contract Pharmacy Representative
Island Infusion Pharmacy
Rafael Rivera, Administrator
(787) 393-0040
Signed By Date
7/15/2024
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