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LARK REXALL DRUGS INC
CH09788A PETALUMA HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PETALUMA HEALTH CENTER, INC.
Subdivision Name
Rohnert Park Health Center
Type
HRSA-Funded Health Center
340B ID
CH09788A
Entity Address
5900 State Farm Dr., Suite 200
Rohnert Park, CA 94928-2149
Grant Number
H80CS00587
Participating Start Date
1/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
LARK REXALL DRUGS INC
Pharmacy Address
DBA LARK DRUGS PHARMACY
16251 MAIN ST
GUERNEVILLE, CA 95446-8300
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Burns, CFO
(707) 559-7588
Contract Pharmacy Representative
Sebastopol Family Pharmacy
Amalia Nocola, President
(707) 869-9055
Signed By Date
7/17/2018
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