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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH0910250 MENDOCINO COAST CLINICS, INC.
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Covered Entity Details
Entity Name
MENDOCINO COAST CLINICS, INC.
Subdivision Name
MENDOCINO COAST CLINICS, INC.
Type
HRSA-Funded Health Center
340B ID
CH0910250
Entity Address
205 South St
Fort Bragg, CA 95437-5540
Grant Number
H80CS00876
Participating Start Date
1/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03932
150 S MAIN ST
FORT BRAGG, CA 95437
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
Lucresha Renteria, Executive Director
(707) 964-1251 Ext: 3433
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2019
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