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LIVE OAK PHARMACY
CH097180 PEACH TREE CLINIC, THE, INC.
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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 BLVD
LIVE OAK, CA 95953
Pharmacy Comments
Contract Details
Approval Date
2/23/2017
Contract Begin Date
4/1/2017
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: 1363
Contract Pharmacy Representative
HARRY RAI, PHARMACIST
(530) 695-5100
Signed By Date
2/23/2017
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