Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC24115-00 SABAN FREE CLINIC, THE

Covered Entity Details

Entity Name

SABAN FREE CLINIC, THE

Subdivision Name

Beverly Health Center

Type

HRSA-Funded Health Center

340B ID

CHC24115-00

Entity Address

8405 Beverly Blvd.
Los Angeles, CA 90048-3401

Grant Number

H80CS24115

Participating Start Date

10/1/2012

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09656
2771 4TH ST
SANTA ROSA, CA 95405

Pharmacy Comments

Contract Details

Approval Date

10/14/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Muriel Nouwezem, CEO
(323) 337-1707

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/14/2019

340B Drug Pricing Program Database