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GREEN'S FORTUNA PHARMACY
CAH051318-00 St Joseph Health Northern California LLC- DBA Redwood Memorial Hospital
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Covered Entity Details
Entity Name
St Joseph Health Northern California LLC- DBA Redwood Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051318-00
Entity Address
3300 Renner Drive
Fortuna, CA 95540
Medicare Provider Number
051318
Participating Start Date
4/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
GREEN'S FORTUNA PHARMACY
Pharmacy Address
1058 MAIN ST
FORTUNA, CA 95540
Pharmacy Comments
Contract Details
Approval Date
5/18/2012
Contract Begin Date
5/18/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joe Rogers, Chief Operating Officer
(707) 725-3361 Ext: 4351
Contract Pharmacy Representative
Green's Fortuna Pharmacy
Robert Johnson, President
(707) 499-2336
Signed By Date
5/16/2012
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