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YREKA PHARMACY
CAH051316-00 Fairchild Medical Center
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Covered Entity Details
Entity Name
Fairchild Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051316-00
Entity Address
444 Bruce St
Yreka, CA 96097
Medicare Provider Number
051316
Participating Start Date
7/1/2013
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
YREKA PHARMACY
Pharmacy Address
748 S. MAIN ST.
YREKA, CA 96097
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Martin, CFO
(530) 841-6235
Contract Pharmacy Representative
Creekside Pharmacy
Tony Ibrahim, CEO/Owner
(707) 525-1130
Signed By Date
10/15/2019
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