Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA263A MAYVIEW COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

MAYVIEW COMMUNITY HEALTH CENTER, INC.

Subdivision Name

MAYVIEW COMMUNITY HEALTH CENTER - MV

Type

Health Center Program Look-Alike

340B ID

FQHCLA263A

Entity Address

900 MIRAMONTE AVENUE
2ND FLOOR
MOUNTAIN VIEW, CA 94040-2457

Grant Number

LALCS00001

Participating Start Date

7/1/2010

Last Recertification Date

1/27/2020

Entity Termination Date

7/1/2020

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09198
1675 HOLLENBECK AVE
SUNNYVALE, CA 94087

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

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kenneth Graham, CEO
(650) 475-1508

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