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RALEY'S PHARMACY #328
CAH051310-00 Willits Hospital Inc., DBA Adventist Health Howard Memorial
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Covered Entity Details
Entity Name
Willits Hospital Inc., DBA Adventist Health Howard Memorial
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051310-00
Entity Address
One Marcela Drive
Willits, CA 95490-5769
Medicare Provider Number
051310
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
RALEY'S PHARMACY #328
Pharmacy Address
1315 NORTH STATE STREET
UKIAH, CA 95482
Pharmacy Comments
Contract Details
Approval Date
8/17/2012
Contract Begin Date
8/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/20/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CARLTON Edward JACOBSON, CHIEF FINANCIAL OFFICER
(707) 456-3001
Contract Pharmacy Representative
Raley's
Flint Pendergraft, Vice President, Pharmacy & Healthy Lifestyle Initiatives
(916) 373-6146
Signed By Date
7/17/2012
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