Contract Pharmacy Details

TD HAWJ CORPORATION DBA LOYALTY PHARMACY
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

TD HAWJ CORPORATION DBA LOYALTY PHARMACY

Pharmacy Address

327 TRINITY AVE
CHOWCHILLA, CA 93610

Pharmacy Comments

Contract Details

Approval Date

4/18/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/12/2017
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Joy Raron, CQO
(209) 383-5200

Contract Pharmacy Representative

Tou Her, Pharmacy Manager
(559) 715-4516

Signed By Date

4/18/2017

340B Drug Pricing Program Database