Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638480 MACT Health Board, Inc.

Covered Entity Details

Entity Name

MACT Health Board, Inc.

Subdivision Name

MACT Medical, Sonora

Type

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

340B ID

FQHC638480

Entity Address

13975 MONO WAY
SUITE G,H, I, J
SONORA, CA 95370

Grant Number

Participating Start Date

1/1/2003

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09539
41 N MAIN ST
ANGELS CAMP, CA 95222

Pharmacy Comments

Contract Details

Approval Date

1/8/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Shawver Alexander, Executive Director
(209) 754-6258

Contract Pharmacy Representative

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

Signed By Date

1/8/2019

340B Drug Pricing Program Database