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HOMETOWN MEDICAL 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 MEDICAL PHARMACY
Pharmacy Address
HOMETOWN MEDICAL PHARMACY
1482 S. BROADWAY
STE A
SANTA MARIA, CA 93454-6914
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/6/2019
Ownership change
Contacts
Covered Entity Signing Official
Ron Sisson, EXECUTIVE DIRECTOR
(805) 694-2650 Ext: 16
Contract Pharmacy Representative
Joseph E. Abraham, President
(805) 928-2200
Signed By Date
10/14/2016
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