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LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC26608-00 COPPERTOWER FAMILY MEDICAL CENTER INC
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Covered Entity Details
Entity Name
COPPERTOWER FAMILY MEDICAL CENTER INC
Subdivision Name
Alexander Valley Regional Medical Center (Medical/Behavioral Health)
Type
HRSA-Funded Health Center
340B ID
CHC26608-00
Entity Address
6 Tarman Dr
Cloverdale, CA 95425-3932
Grant Number
H80CS26608
Participating Start Date
7/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00345
1111 S CLOVERDALE BLVD
CLOVERDALE, CA 95425
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah Howell, CEO
(707) 894-4229
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2019
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