Contract Pharmacy Details

SAN JOAQUIN DRUG
FQHCLA338 HORISONS UNLIMITED

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

SAN JOAQUIN DRUG

Pharmacy Address

9215 EAST HIGHWAY 140
P.O. BOX 1636
PLANADA, CA 95365

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

Yosemite Drug
Katie Bass, PIC
(209) 382-1291

Signed By Date

1/15/2016