Contract Pharmacy Details

TAOS PHARMACY
CH060330 EL CENTRO FAMILY HEALTH

Covered Entity Details

Entity Name

EL CENTRO FAMILY HEALTH

Subdivision Name

Type

HRSA-Funded Health Center

340B ID

CH060330

Entity Address

620 CORONADO STREET
ESPANOLA, NM 87532

Grant Number

H80CS00605

Participating Start Date

8/1/1993

Last Recertification Date

3/8/2016

Entity Termination Date

4/1/2016

Pharmacy Details

Pharmacy Name

TAOS PHARMACY

Pharmacy Address

622 A PASEO DEL PUEBLO SUR
5401 NDCBU
TAOS, NM 87571

Pharmacy Comments

Contract Details

Approval Date

9/9/2011

Contract Begin Date

9/9/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2016

Contacts

Covered Entity Signing Official

Lore Pease, CEO
(505) 753-7218

Contract Pharmacy Representative

Jake Mossman, Owner
(575) 758-3342

Signed By Date

7/25/2011