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PIONEER MARKET PHARMACY
FQHCLA338 HORISONS UNLIMITED
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Covered Entity Details
Entity Name
HORISONS UNLIMITED
Subdivision Name
Horisons Unlimited Mariposa
Type
Health Center Program Look-Alike
340B ID
FQHCLA338
Entity Address
5320 STATE HIGHWAY 49 N
MARIPOSA, CA 95338-9588
Grant Number
LALCS00172
Participating Start Date
1/1/2016
Last Recertification Date
1/27/2017
Entity Termination Date
10/12/2017
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
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sandy Haar, CEO
(209) 201-2099
Contract Pharmacy Representative
Carl Wood, Pharmacist
(209) 742-5550
Signed By Date
1/15/2016
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