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CREEKSIDE PHARMACY
CH098790 SANTA ROSA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
SANTA ROSA COMMUNITY HEALTH CENTERS
Subdivision Name
LOMBARDI CAMPUS
Type
HRSA-Funded Health Center
340B ID
CH098790
Entity Address
751 LOMBARDI COURT STE B
SANTA ROSA, CA 95407
Grant Number
H80CS00259
Participating Start Date
4/1/2003
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
CREEKSIDE PHARMACY
Pharmacy Address
95 MONTGOMERY DR.
STE. 108
SANTA ROSA, CA 95404
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gabriela Bernal Leroi, Chief Executive Officer
(415) 312-9646
Contract Pharmacy Representative
Creekside Pharmacy
Tony Ibrahim, CEO/Owner
(707) 525-1130
Signed By Date
4/15/2024
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