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MINI PHARMACY ENTERPRISES, INC.
FQHC638012B NORTHERN VALLEY INDIAN HEALTH
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Covered Entity Details
Entity Name
NORTHERN VALLEY INDIAN HEALTH
Subdivision Name
Red Bluff Clinic
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012B
Entity Address
2500 N MAIN STREET
RED BLUFF, CA 96080
Grant Number
Participating Start Date
4/1/2011
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
MINI PHARMACY ENTERPRISES, INC.
Pharmacy Address
2425 PORTER ST
LOS ANGELES, CA 90021-2510
Pharmacy Comments
Contract Details
Approval Date
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
INDER WADHWA, CHIEF EXECUTIVE OFFICER
(530) 896-9409
Contract Pharmacy Representative
Mini Pharmacy
Richard Fox, Vice President
(323) 221-6000
Signed By Date
1/9/2020
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