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RIVERSIDE 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
RIVERSIDE PHARMACY
Pharmacy Address
SCRIPT DEPOT LP DBA
866 PLUMAS ST STE C
YUBA CITY, CA 95991
Pharmacy Comments
Contract Details
Approval Date
12/7/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cindy Anne Snelgrove, Chief Clinical Services Officer
(530) 751-3755
Contract Pharmacy Representative
Khaled Sedki, Owner
(530) 674-3277
Signed By Date
12/7/2016
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