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LARK REXALL DRUGS INC
FP95407 SANTA ROSA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
SANTA ROSA COMMUNITY HEALTH CENTERS
Subdivision Name
ELSIE ALLEN CAMPUS
Type
Family Planning (Title X only)
340B ID
FP95407
Entity Address
599 BELLEVUE AVENUE
SANTA ROSA, CA 95407
Grant Number
FPHPA096061
Participating Start Date
9/9/2005
Last Recertification Date
5/11/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
LARK REXALL DRUGS INC
Pharmacy Address
DBA LARK DRUGS PHARMACY
16251 MAIN ST
GUERNEVILLE, CA 95446-8300
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gabriela Bernal Leroi, Chief Executive Officer
(415) 312-9646
Contract Pharmacy Representative
Santa Rose Community Centers
Amalia Nicola, President
(707) 869-9055
Signed By Date
10/16/2023
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