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HAGGEN OPCO NORTH, LLC
CH09175A MOUNTAIN VALLEYS HEALTH CENTERS
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Covered Entity Details
Entity Name
MOUNTAIN VALLEYS HEALTH CENTERS
Subdivision Name
TULELAKE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH09175A
Entity Address
498 MAIN STREET
TULELAKE, CA 96134-0725
Grant Number
H80CS00260
Participating Start Date
4/1/2002
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
HAGGEN OPCO NORTH, LLC
Pharmacy Address
HAGGEN PHARMACY #2122
2740 S 6TH
KLAMATH FALLS, OR 97603
Pharmacy Comments
Contract Details
Approval Date
8/4/2015
Contract Begin Date
8/11/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/11/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
DAVE JONES, CEO
(530) 294-5241
Contract Pharmacy Representative
Mike Arndorfer, Pharmacy Vice President
(360) 650-8210
Signed By Date
8/4/2015
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