Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, 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

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03066
8351 ELK GROVE FLORIN RD
SACRAMENTO, CA 95829

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