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VISTA CLINIC PHARMACY
CH09879AE SANTA ROSA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
SANTA ROSA COMMUNITY HEALTH CENTERS
Subdivision Name
Caritas Campus
Type
HRSA-Funded Health Center
340B ID
CH09879AE
Entity Address
301 6th St STE 214
Santa Rosa, CA 95401
Grant Number
H80CS00259
Participating Start Date
1/1/2023
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
VISTA CLINIC PHARMACY
Pharmacy Address
3569A ROUND BARN CIRCLE
SANTA ROSA, CA 95403
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
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gabriela Bernal Leroi, Chief Executive Officer
(415) 312-9646
Contract Pharmacy Representative
Cardinal Health
Naveen Mansukhani, National Operations Director
(732) 328-0515
Signed By Date
10/16/2023
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