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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA247A HEALTH AND LIFE ORGANIZATION INC.
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION INC.
Subdivision Name
SACRAMENTO COMMUNITY CLINIC - DEL PASO
Type
Health Center Program Look-Alike
340B ID
FQHCLA247A
Entity Address
2200 DEL PASO BLVD
SACRAMENTO, CA 95815
Grant Number
LALCS00018
Participating Start Date
4/1/2009
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04151
2050 CLUB CENTER DR
SACRAMENTO, CA 95835
Pharmacy Comments
Contract Details
Approval Date
1/2/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/2/2020
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