Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA247 HEALTH AND LIFE ORGANIZATION INC.

Covered Entity Details

Entity Name

HEALTH AND LIFE ORGANIZATION INC.

Subdivision Name

SACRAMENTO COMMUNITY CLINIC - SOUTHGATE

Type

Health Center Program Look-Alike

340B ID

FQHCLA247

Entity Address

7275 E. SOUTHGATE DRIVE
SUITE 204
SACRAMENTO, CA 95823

Grant Number

LALCS00018

Participating Start Date

4/1/2009

Last Recertification Date

1/31/2023

Entity Termination Date

10/1/2023

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09823
1350 FLORIN ROAD
SACRAMENTO, CA 95822

Pharmacy Comments

Contract Details

Approval Date

10/15/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236

Contract Pharmacy Representative

WellPartner, A CVS Health Company
Derek Sterns, National Sales Representative
(503) 317-9840

Signed By Date

10/15/2018

340B Drug Pricing Program Database