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COTTONWOOD DRUGS
CH0911800 SHINGLETOWN MEDICAL CENTER
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Covered Entity Details
Entity Name
SHINGLETOWN MEDICAL CENTER
Subdivision Name
SHINGLETOWN MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH0911800
Entity Address
31292 Alpine Meadows Rd
Shingletown, CA 96088-9462
Grant Number
H80CS01440
Participating Start Date
7/1/2004
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
COTTONWOOD DRUGS
Pharmacy Address
20635 GAS POINT ROAD
P.O. BOX 588
COTTONWOOD, CA 96022
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/3/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tami Fraser, CEO
(530) 474-3390 Ext: 307
Contract Pharmacy Representative
Bernard Christopher, Owner
(530) 347-3721
Signed By Date
1/15/2015
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