Contract Pharmacy Details

GKN RX INC
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

GKN RX INC

Pharmacy Address

1471 B ST STE R
LIVINGSTON, CA 95334-1426

Pharmacy Comments

Contract Details

Approval Date

10/3/2016

Contract Begin Date

1/1/2017

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

Pratap K. Anne, Director
(209) 398-2035

Signed By Date

10/3/2016