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VISTA CLINIC PHARMACY
CH09879AC SANTA ROSA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
SANTA ROSA COMMUNITY HEALTH CENTERS
Subdivision Name
Bridge Campus
Type
HRSA-Funded Health Center
340B ID
CH09879AC
Entity Address
2235 Challenger Way, Ste 109
Santa Rosa, CA 95407-5421
Grant Number
H80CS00259
Participating Start Date
11/21/2018
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
VISTA CLINIC PHARMACY
Pharmacy Address
3569A ROUND BARN CIRCLE
SANTA ROSA, CA 95403
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Naomi Fuchs, CEO
(707) 303-3600 Ext: 3111
Contract Pharmacy Representative
Cardinal Health
Naveen Mansukhani, National Operations Director
(732) 328-0515
Signed By Date
4/14/2020
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