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LIVE OAK PHARMACY
CAH051311-00 ORCHARD HOSPITAL
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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 BLVD
LIVE OAK, CA 95953
Pharmacy Comments
Contract Details
Approval Date
4/12/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Steven Stark, CEO
(530) 846-5671
Contract Pharmacy Representative
Live Oak Pharmacy
Harinder Rai, CEO
(530) 695-5102
Signed By Date
4/12/2017
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