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LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC24115-00 SABAN FREE CLINIC, THE
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Covered Entity Details
Entity Name
SABAN FREE CLINIC, THE
Subdivision Name
Beverly Health Center
Type
HRSA-Funded Health Center
340B ID
CHC24115-00
Entity Address
8405 Beverly Blvd.
Los Angeles, CA 90048-3401
Grant Number
H80CS24115
Participating Start Date
10/1/2012
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09144
7021 HOLLYWOOD BLVD
LOS ANGELES, CA 90028
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Muriel Nouwezem, CEO
(323) 337-1707
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2020
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