Contract Pharmacy Details

PIONEER DRUG #2
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

PIONEER DRUG #2

Pharmacy Address

397 5TH ST
GUSTINE, CA 95322-1236

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

Pioneer Pharmacy
Ralph Klopping, Owner & Pharmacist
(209) 854-1007

Signed By Date

10/3/2016

340B Drug Pricing Program Database