Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
CHC28984-02 CENTER FOR FAMILY HEALTH & EDUCATION, INC.

Covered Entity Details

Entity Name

CENTER FOR FAMILY HEALTH & EDUCATION, INC.

Subdivision Name

Priority Care Medical Group Long Beach

Type

HRSA-Funded Health Center

340B ID

CHC28984-02

Entity Address

500 West Willow Street
Long Beach, CA 90806-2831

Grant Number

H80CS28984

Participating Start Date

7/1/2019

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09572
5117 LAKEWOOD BOULEVARD
LAKEWOOD, CA 90712

Pharmacy Comments

Contract Details

Approval Date

7/3/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/17/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Marisol Ramirez, Chief Administrative Officer
(818) 899-5555 Ext: 105

Contract Pharmacy Representative

Center for Family Health and Education
Steven Sanzo, Chief Administrative Officer
(818) 899-5555

Signed By Date

7/3/2019

340B Drug Pricing Program Database