Contract Pharmacy Details

OWENS PHARMACY #16
FQHC638005 GREENVILLE RANCHERIA TRIBAL HEALTH

Covered Entity Details

Entity Name

GREENVILLE RANCHERIA TRIBAL HEALTH

Subdivision Name

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638005

Entity Address

410 MAIN STREET
GREENVILLE, CA 95947

Grant Number

Participating Start Date

7/1/2016

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

OWENS PHARMACY #16

Pharmacy Address

2920 A MAIN ST
SUSANVILLE, CA 96130

Pharmacy Comments

Contract Details

Approval Date

4/5/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/10/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Lucretia Fletcher, Tribal Administrator
(530) 528-8600 Ext: 200

Contract Pharmacy Representative

Jamie Ingram, Corporate Controller
(530) 246-1075

Signed By Date

4/5/2017

340B Drug Pricing Program Database