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MENDOCINO PHARMACY HOLDINGS INC.
CH096030 Redwood Coast Medical Services Inc
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Covered Entity Details
Entity Name
Redwood Coast Medical Services Inc
Subdivision Name
REDWOOD COAST MEDICAL SERVICES
Type
HRSA-Funded Health Center
340B ID
CH096030
Entity Address
46900 Ocean Dr
Gualala, CA 95445-8353
Grant Number
H80CS00575
Participating Start Date
4/16/2019
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MENDOCINO PHARMACY HOLDINGS INC.
Pharmacy Address
DBA MENDOCINO VILLAGE PHARMACY
10501 LANSING STREET
PO BOX 904
MENDOCINO, CA 95460
Pharmacy Comments
Contract Details
Approval Date
7/30/2020
Contract Begin Date
8/3/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/17/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Ara Chakrabarti, CEO
(707) 884-4005 Ext: 137
Contract Pharmacy Representative
Mendocino Village Pharmacy
Kelly Brodetsky, Owner
(707) 962-0800
Signed By Date
7/30/2020
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