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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638005 GREENVILLE RANCHERIA TRIBAL HEALTH
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Covered Entity Details
Entity Name
GREENVILLE RANCHERIA TRIBAL HEALTH
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638005
Entity Address
410 MAIN STREET
GREENVILLE, CA 95947
Grant Number
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
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
10/7/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucretia Fletcher, Tribal Administrator
(530) 528-8600 Ext: 200
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2019
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