Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
CHC26613-00 ANTELOPE VALLEY COMMUNITY CLINIC

Covered Entity Details

Entity Name

ANTELOPE VALLEY COMMUNITY CLINIC

Subdivision Name

Antelope Valley Community Clinic - Health and Wellness Center

Type

HRSA-Funded Health Center

340B ID

CHC26613-00

Entity Address

45104 10th St W
Lancaster, CA 93534-2310

Grant Number

H80CS26613

Participating Start Date

4/1/2014

Last Recertification Date

2/1/2019

Entity Termination Date

10/1/2019

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16206
39440 10TH ST W
PALMDALE, CA 93551

Pharmacy Comments

Contract Details

Approval Date

10/9/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

James A. Cook, CEO
(661) 942-2391

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/9/2018

340B Drug Pricing Program Database