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LARK REXALL DRUGS INC
CH09879T SANTA ROSA COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
SANTA ROSA COMMUNITY HEALTH CENTERS
Subdivision Name
TEMPORARY SITE-Santa Rosa Community Health Center Mobile Clinic 2
Type
HRSA-Funded Health Center
340B ID
CH09879T
Entity Address
751 Lombardi Ct
Santa Rosa, CA 95407-6798
Grant Number
H80CS00259
Participating Start Date
11/3/2017
Last Recertification Date
2/11/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
LARK REXALL DRUGS INC
Pharmacy Address
DBA LARK DRUGS PHARMACY
16251 MAIN ST
GUERNEVILLE, CA 95446-8300
Pharmacy Comments
Contract Details
Approval Date
12/15/2017
Contract Begin Date
12/13/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Naomi Fuchs, CEO
(707) 303-3600 Ext: 3111
Contract Pharmacy Representative
Santa Rose Community Centers
Amalia Nicola, President
(707) 869-9055
Signed By Date
12/15/2017
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