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ESI MAIL PHARMACY SERVICE
CAH051316-00 Fairchild Medical Center
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Covered Entity Details
Entity Name
Fairchild Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051316-00
Entity Address
444 Bruce St
Yreka, CA 96097
Medicare Provider Number
051316
Participating Start Date
7/1/2013
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
ESI MAIL PHARMACY SERVICE
Pharmacy Address
DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Martin, CFO
(530) 841-6235
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Senior Director 340B sales
(615) 943-7500
Signed By Date
4/14/2023
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