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IMGRX SONOMA, INC
CH097880 PETALUMA HEALTH CENTER, INC
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Covered Entity Details
Entity Name
PETALUMA HEALTH CENTER, INC
Subdivision Name
Petaluma Health Center
Type
HRSA-Funded Health Center
340B ID
CH097880
Entity Address
1179 N. McDowell Blvd.
Petaluma, CA 94954-6559
Grant Number
H80CS00587
Participating Start Date
7/1/2000
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
IMGRX SONOMA, INC
Pharmacy Address
DBA SONOMA VALLEY COMMUNITY PHARMACY
19270 SONOMA HWY, SUITE A
SONOMA, CA 95476
Pharmacy Comments
Contract Details
Approval Date
1/9/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Molly Jouaneh, Chief Financial Officer
(707) 559-7500
Contract Pharmacy Representative
Cardinal Health
Naveen Mansukhani, National Operations Director
(732) 328-0515
Signed By Date
1/9/2024
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