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MARIN APOTHECARIES, INC.
CH09879R SANTA ROSA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
SANTA ROSA COMMUNITY HEALTH CENTERS
Subdivision Name
Santa Rosa Mobile Clinic
Type
HRSA-Funded Health Center
340B ID
CH09879R
Entity Address
parked overnight at 3569 Round Barn Circle
Santa Rosa, CA 95403
Grant Number
H80CS00259
Participating Start Date
7/1/2014
Last Recertification Date
1/30/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
MARIN APOTHECARIES, INC.
Pharmacy Address
DUTTON COMMUNITY PHARMACY
1300 NORTH DUTTON AVENUE
SUITE 100
SANTA ROSA, CA 95401
Pharmacy Comments
Contract Details
Approval Date
1/6/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kai Nissley, COO
(707) 303-3600 Ext: 3430
Contract Pharmacy Representative
Cristie Pellegrini, Regional Director of Pharmacies
(512) 596-2930 Ext: 706
Signed By Date
1/6/2015
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