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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA002A COUNTY OF MONTEREY
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Covered Entity Details
Entity Name
COUNTY OF MONTEREY
Subdivision Name
MARINA CLINIC
Type
Health Center Program Look-Alike
340B ID
FQHCLA002A
Entity Address
3155 DEFOREST ROAD
MARINA, CA 93933
Grant Number
LALCS00049
Participating Start Date
10/1/2001
Last Recertification Date
1/31/2019
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03050
268 RESERVATION RD
MARINA, CA 93933
Pharmacy Comments
Contract Details
Approval Date
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Julia C. Edgcomb, Clinic Services Bureau Chief/Director
(831) 796-1386
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/8/2019
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