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GATEWAY PHARMACY
DSH050367 NorthBay Healthcare Group
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Covered Entity Details
Entity Name
NorthBay Healthcare Group
Subdivision Name
NORTH BAY MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050367
Entity Address
1200 B GALE WILSON BLVD
FAIRFIELD, CA 94533
Medicare Provider Number
050367
Participating Start Date
7/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
GATEWAY PHARMACY
Pharmacy Address
SARHADDI PHARMACEUTICAL INC
1330 GATEWAY BLVD STE B-2
FAIRFIELD, CA 94533-6915
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ART DENIO, CFO
(707) 646-3111
Contract Pharmacy Representative
Ali Sarhaddi, Pharmacy Manager
(707) 422-0500
Signed By Date
4/12/2013
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