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DEMARTINI SPRING HILL PHCY INC
CHC28981-00 WESTERN SIERRA MEDICAL CLINIC INC
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Covered Entity Details
Entity Name
WESTERN SIERRA MEDICAL CLINIC INC
Subdivision Name
Sierra Family Medical Clinic, Oregon House
Type
HRSA-Funded Health Center
340B ID
CHC28981-00
Entity Address
8676 Marysville Rd.
Oregon House, CA 95962-9718
Grant Number
H80CS08234
Participating Start Date
4/1/2016
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
DEMARTINI SPRING HILL PHCY INC
Pharmacy Address
DEMARTINI'S COMPOUNDING CENTER
102 CATHERINE LANE
GRASS VALLEY, CA 95945-9594
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Graeber, Senior Accountant
(530) 292-3478 Ext: 219
Contract Pharmacy Representative
DAVID DEMARTINI, PRESIDENT
(530) 273-2268
Signed By Date
4/15/2016
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