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OWENS PHARMACY #21
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
OWENS PHARMACY #21
Pharmacy Address
9387 DESCHUTES ROAD
SUITE 1
PALO CEDRO, CA 96073
Pharmacy Comments
Contract Details
Approval Date
4/20/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Tami Fraser, CEO
(530) 474-3390 Ext: 307
Contract Pharmacy Representative
Jamie Ingram, Corporate Controller
(530) 246-1075
Signed By Date
4/20/2015
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