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GREEN'S FORTUNA PHARMACY
CH097210 The WeCare Group
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Covered Entity Details
Entity Name
The WeCare Group
Subdivision Name
The WeCare Group
Type
HRSA-Funded Health Center
340B ID
CH097210
Entity Address
321 VAN DUZEN ROAD
MAD RIVER, CA 95526
Grant Number
H80CS04431
Participating Start Date
7/1/2005
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GREEN'S FORTUNA PHARMACY
Pharmacy Address
1058 MAIN ST
FORTUNA, CA 95540
Pharmacy Comments
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lee Lupton, CEO
(707) 574-6616 Ext: 2040
Contract Pharmacy Representative
Green's Fortuna Pharmacy
Robert Johnson, President
(707) 499-2336
Signed By Date
4/4/2017
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