Contract Pharmacy Details

LIVE OAK PHARMACY
CAH051311-00 ORCHARD HOSPITAL

Covered Entity Details

Entity Name

ORCHARD HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH051311-00

Entity Address

240 SPRUCE ST.
GRIDLEY, CA 95948

Medicare Provider Number

051311

Participating Start Date

1/1/2011

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

LIVE OAK PHARMACY

Pharmacy Address

9970 LIVE OAK BOULEVARD
LIVE OAK, CA 95953

Pharmacy Comments

Contract Details

Approval Date

4/10/2012

Contract Begin Date

4/10/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/3/2017
Ownership change

Contacts

Covered Entity Signing Official

Wade Sturgeon, CFO
(530) 846-9036

Contract Pharmacy Representative

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

Signed By Date

3/26/2012