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GARFIELD BEACH CVS, L.L.C.
FQHCLA382 LAGUNA BEACH COMMUNITY CLINIC INC
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Covered Entity Details
Entity Name
LAGUNA BEACH COMMUNITY CLINIC INC
Subdivision Name
Laguna Beach Community Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA382
Entity Address
362 Third Street
Laguna Beach, CA 92651
Grant Number
LALCS32582
Participating Start Date
4/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08851
24271 MUIRLANDS BLVD
LAKE FOREST, CA 92630
Pharmacy Comments
Contract Details
Approval Date
4/1/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Jorge Rubal, C.E.O. / C.M.O.
(949) 494-0761 Ext: 132
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2019
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