Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
CH091014F COMMUNITY HEALTH ALLIANCE OF PASADENA

Covered Entity Details

Entity Name

COMMUNITY HEALTH ALLIANCE OF PASADENA

Subdivision Name

ChapCare Dental

Type

HRSA-Funded Health Center

340B ID

CH091014F

Entity Address

1855 N. FAIR OAKS AVE STE G-100
PASADENA, CA 91103-1620

Grant Number

H80CS04220

Participating Start Date

1/1/2015

Last Recertification Date

2/2/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09668
727 S. ARROYO PARKWAY
PASADENA, CA 91105

Pharmacy Comments

Contract Details

Approval Date

1/9/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Sergio Bautista, Executive Deputy Director
(626) 993-1215

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/9/2020

340B Drug Pricing Program Database