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SHAFTER MEDICAL PHARMACY
CH091600 Omni Family Health
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Covered Entity Details
Entity Name
Omni Family Health
Subdivision Name
Omni Family Health
Type
HRSA-Funded Health Center
340B ID
CH091600
Entity Address
277 East Front Street
Buttonwillow, CA 93206
Grant Number
H80CS00615
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SHAFTER MEDICAL PHARMACY
Pharmacy Address
825 CENTRAL VALLEY HWY
SHAFTER, CA 93263-2078
Pharmacy Comments
Contract Details
Approval Date
4/14/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/11/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diego Martinez, Chief Operations Officer
(661) 630-7030
Contract Pharmacy Representative
Shafter Medical Pharmacy #1
Iskander Hussein, President
(661) 746-5600
Signed By Date
4/14/2018
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