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VISTA CLINIC PHARMACY
FP95407 SANTA ROSA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
SANTA ROSA COMMUNITY HEALTH CENTERS
Subdivision Name
ELSIE ALLEN CAMPUS
Type
Family Planning (Title X only)
340B ID
FP95407
Entity Address
599 BELLEVUE AVENUE
SANTA ROSA, CA 95407
Grant Number
FPHPA096061
Participating Start Date
9/9/2005
Last Recertification Date
5/11/2023
Entity Termination Date
7/1/2024
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
Covered Entity Terminated
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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