Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638017 SANTA YNEZ TRIBAL HEALTH CLINIC

Covered Entity Details

Entity Name

SANTA YNEZ TRIBAL HEALTH CLINIC

Subdivision Name

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638017

Entity Address

90 VIA JUANA LANE
SANTA YNEZ, CA 93460

Grant Number

Participating Start Date

1/1/1995

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09821
2116 S BROADWAY
SANTA MARIA, CA 93454

Pharmacy Comments

Contract Details

Approval Date

10/15/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ron Sisson, EXECUTIVE DIRECTOR
(805) 694-2650 Ext: 16

Contract Pharmacy Representative

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

Signed By Date

10/15/2018

340B Drug Pricing Program Database