Contract Pharmacy Details

SAVE MART PHARMACY #608
FQHCLA106 SIERRA FAMILY MEDICAL CLINIC, INC.

Covered Entity Details

Entity Name

SIERRA FAMILY MEDICAL CLINIC, INC.

Subdivision Name

Type

Health Center Program Look-Alike

340B ID

FQHCLA106

Entity Address

15301 TYLER FOOTE ROAD
NEVADA CITY, CA 95959

Grant Number

LALCS00058

Participating Start Date

4/1/2002

Last Recertification Date

2/2/2015

Entity Termination Date

4/1/2016

Pharmacy Details

Pharmacy Name

SAVE MART PHARMACY #608

Pharmacy Address

12054 NEVADA CITY HWY
GRASS VALLEY, CA 95945

Pharmacy Comments

Contract Details

Approval Date

1/16/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Steve Weber, CEO
(530) 292-3478 Ext: 230

Contract Pharmacy Representative

Robert Vaughan, Senior Director of Pharmacy Operations
(209) 574-6220

Signed By Date

1/16/2015

340B Drug Pricing Program Database