Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
FQHCLA247C HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)

Covered Entity Details

Entity Name

HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)

Subdivision Name

Sacramento Community Clinic - Del Paso Dental

Type

Health Center Program Look-Alike

340B ID

FQHCLA247C

Entity Address

2138 Del Paso Blvd
Sacramento, CA 95815-3002

Grant Number

LALCS00018

Participating Start Date

1/1/2014

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04950
3301 ZINFANDEL DR.
RANCHO CORDOVA, CA 95670

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

340B Drug Pricing Program Database