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LUCKY PHARMACY #731
CH092420 OLE HEALTH
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Covered Entity Details
Entity Name
OLE HEALTH
Subdivision Name
OLE Health - North Napa Campus
Type
HRSA-Funded Health Center
340B ID
CH092420
Entity Address
1141 PEAR TREE LANE
Suite 100
NAPA, CA 94558-6485
Grant Number
H80CS04219
Participating Start Date
10/1/2004
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
LUCKY PHARMACY #731
Pharmacy Address
1312 TRANCAS STREET
NAPA, CA 94558
Pharmacy Comments
Contract Details
Approval Date
1/6/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/15/2022
Ownership change
Contacts
Covered Entity Signing Official
Tanir Ami, Chief Executive Officer
(707) 254-1770 Ext: 214
Contract Pharmacy Representative
Robert Vaughan, Senior Director of Pharmacy Operations
(209) 574-6220
Signed By Date
1/6/2014
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