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MORAN'S PHARMACY
FQHC638009 LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC
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Covered Entity Details
Entity Name
LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638009
Entity Address
925 BEVINS COURT
LAKEPORT, CA 95453
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MORAN'S PHARMACY
Pharmacy Address
15175 LAKESHORE DR
CLEARLAKE, CA 95422-8106
Pharmacy Comments
Contract Details
Approval Date
4/25/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/20/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Emmanuel Yennyemb, COO
(707) 263-8382 Ext: 1202
Contract Pharmacy Representative
Guinder S. Grewal, owner
(707) 994-6440
Signed By Date
4/25/2014
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