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DOLPHIN HEALTH PHARMACY
CHC24113-00 Elica Health Centers
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Covered Entity Details
Entity Name
Elica Health Centers
Subdivision Name
Elica Health Centers
Type
HRSA-Funded Health Center
340B ID
CHC24113-00
Entity Address
155 15th St
West Sacramento, CA 95691
Grant Number
H80CS24113
Participating Start Date
1/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
DOLPHIN HEALTH PHARMACY
Pharmacy Address
7400 MACARTHUR BLVD
SUITE A
OAKLAND, CA 94605
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/2/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David E Hughes, COO/CFO
(916) 569-8484 Ext: 312
Contract Pharmacy Representative
Dolphin Health Pharmacy
Nital Patel, Owner
(510) 638-1321
Signed By Date
10/11/2019
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