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CLOVERDALE PHARMACY
CHC26608-01 COPPERTOWER FAMILY MEDICAL CENTER INC
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Covered Entity Details
Entity Name
COPPERTOWER FAMILY MEDICAL CENTER INC
Subdivision Name
Alexander Valley Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26608-01
Entity Address
100 W Third St.
Cloverdale, CA 95425-3204
Grant Number
H80CS26608
Participating Start Date
1/1/2015
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
CLOVERDALE PHARMACY
Pharmacy Address
790 S CLOVERDALE BLVD
CLOVERDALE, CA 95425-4010
Pharmacy Comments
Contract Details
Approval Date
10/17/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Fred Besio, Owner
(707) 894-4414
Signed By Date
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