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MEDI-MART PHARMACY
CH090850 AMPLA HEALTH
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Covered Entity Details
Entity Name
AMPLA HEALTH
Subdivision Name
Ampla Health Lindhurst Medical, Dental, & Xpress Care
Type
HRSA-Funded Health Center
340B ID
CH090850
Entity Address
4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Grant Number
H80CS00765
Participating Start Date
1/1/1998
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
MEDI-MART PHARMACY
Pharmacy Address
5993 LINDHURST AVENUE
MARYSVILLE, CA 95901
Pharmacy Comments
Contract Details
Approval Date
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
Cindy Anne Snelgrove, Chief Clinical Services Officer
(530) 751-3755
Contract Pharmacy Representative
Benjamin Yuh, General Manager
(530) 742-8808
Signed By Date
7/15/2015
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