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HOMETOWN LTC PHARMACY
FQHC638017 SANTA YNEZ TRIBAL HEALTH CLINIC
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Covered Entity Details
Entity Name
SANTA YNEZ TRIBAL HEALTH CLINIC
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638017
Entity Address
90 VIA JUANA LANE
SANTA YNEZ, CA 93460
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
HOMETOWN LTC PHARMACY
Pharmacy Address
HOMETOWN LTC PHARMACY
1450 W MCCOY LN STE B
SANTA MARIA, CA 93455-1059
Pharmacy Comments
Contract Details
Approval Date
10/14/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/4/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Ron Sisson, EXECUTIVE DIRECTOR
(805) 694-2650 Ext: 16
Contract Pharmacy Representative
JOSEPH E. ABRAHAM, OWNER/MANAGER
(805) 922-6515
Signed By Date
10/14/2013
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