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DAVISON DRUG & STATIONERY
SCH050434-00 Colusa Regional Medical Center
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Covered Entity Details
Entity Name
Colusa Regional Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH050434-00
Entity Address
199 E. Webster St.
Colusa, CA 95932
Medicare Provider Number
050434
Participating Start Date
4/1/2012
Last Recertification Date
9/8/2016
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
DAVISON DRUG & STATIONERY
Pharmacy Address
640 MARKET ST
COLUSA, CA 95932-2441
Pharmacy Comments
Contract Details
Approval Date
3/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Terry Deak, Chief Financial Officer
(530) 458-5821 Ext: 252
Contract Pharmacy Representative
Frank Davison, Owner
(530) 458-2188
Signed By Date
1/12/2013
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