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RALEY'S PHARMACY #123
SCH290019-00 CARSON TAHOE REGIONAL HEALTHCARE
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Covered Entity Details
Entity Name
CARSON TAHOE REGIONAL HEALTHCARE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH290019-00
Entity Address
1600 MEDICAL PARKWAY
CARSON CITY, NV 89703
Medicare Provider Number
290019
Participating Start Date
1/1/2024
Last Recertification Date
8/14/2024
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
RALEY'S PHARMACY #123
Pharmacy Address
176 W. GOLDFIELD AVE.
YERINGTON, NV 89447
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mitchell Curtis Watson, Chief Financial Officer
(775) 445-5543
Contract Pharmacy Representative
Raley's
Cindy Fong, Director of Pharmacy
(916) 373-6411
Signed By Date
4/15/2021
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