Contract Pharmacy Details

LIVE OAK PHARMACY
CH097180 PEACH TREE CLINIC, THE, INC.

Covered Entity Details

Entity Name

PEACH TREE CLINIC, THE, INC.

Subdivision Name

Peach Tree Clinic, Inc

Type

HRSA-Funded Health Center

340B ID

CH097180

Entity Address

5730 Packard Ave., STE 500
Marysville, CA 95901-7119

Grant Number

H80CS06629

Participating Start Date

1/1/2008

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

LIVE OAK PHARMACY

Pharmacy Address

9970 LIVE OAK BOULEVARD
LIVE OAK, CA 95953

Pharmacy Comments

Contract Details

Approval Date

2/21/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/31/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Greg Stone, CEO
(530) 741-6245 Ext: 107

Contract Pharmacy Representative

Ranjit Singh, CEO
(530) 695-5100 Ext: 0

Signed By Date

1/15/2013

340B Drug Pricing Program Database