Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638480 MACT Health Board, Inc.

Covered Entity Details

Entity Name

MACT Health Board, Inc.

Subdivision Name

MACT Medical, Sonora

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638480

Entity Address

13975 MONO WAY
SUITE G,H, I, J
SONORA, CA 95370

Grant Number

Participating Start Date

1/1/2003

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09233
515 S STATE HIGHWAY 49
JACKSON, CA 95642

Pharmacy Comments

Contract Details

Approval Date

10/5/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Shawver Alexander, Executive Director
(209) 754-6258

Contract Pharmacy Representative

CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467

Signed By Date

10/5/2015

340B Drug Pricing Program Database