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ADVENTIST HEALTH HOWARD MEMORIAL
FQHC638409 CONSOLIDATED TRIBAL HEALTH PROJECT
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Covered Entity Details
Entity Name
CONSOLIDATED TRIBAL HEALTH PROJECT
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638409
Entity Address
6991 N. STATE STREET
REDWOOD VALLEY, CA 95470
Grant Number
Participating Start Date
7/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
ADVENTIST HEALTH HOWARD MEMORIAL
Pharmacy Address
3 MARCELA DR STE B
WILLITS, CA 95490-5769
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/10/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARY ANN GONZALEZ, ACTING DIRECTOR
(707) 485-5115 Ext: 5634
Contract Pharmacy Representative
Howard Hospital
Judson Howe, PBM
(707) 456-3005
Signed By Date
10/6/2020
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