340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GREEN'S FORTUNA PHARMACY
FQHC638024 UNITED INDIAN HEALTH SERVICES
Print
Covered Entity Details
Entity Name
UNITED INDIAN HEALTH SERVICES
Subdivision Name
POTAWAT CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638024
Entity Address
1600 WEEOT WAY
ARCATA, CA 95521
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
GREEN'S FORTUNA PHARMACY
Pharmacy Address
1058 MAIN ST
FORTUNA, CA 95540
Pharmacy Comments
Contract Details
Approval Date
7/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Baland, CFO
(707) 825-4065
Contract Pharmacy Representative
Green's Fortuna Pharmacy
Robert Johnson, President
(707) 499-2336
Signed By Date
7/11/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session