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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638013 PIT RIVER HEALTH SERVICES
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Covered Entity Details
Entity Name
PIT RIVER HEALTH SERVICES
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638013
Entity Address
36977 PARK AVE.
BURNEY, CA 96013
Grant Number
Participating Start Date
7/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03911
1060 E CYPRESS AVE
REDDING, CA 96002
Pharmacy Comments
Contract Details
Approval Date
9/21/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Glenna Moore, Executive Director
(530) 335-5090 Ext: 130
Contract Pharmacy Representative
WellPartner, A CVS Health Company
Derek Sterns, National Sales Representative
(503) 317-9840
Signed By Date
9/21/2019
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