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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH095380 Marin Community Clinic
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Covered Entity Details
Entity Name
Marin Community Clinic
Subdivision Name
Marin Community Clinic - Larkspur
Type
HRSA-Funded Health Center
340B ID
CH095380
Entity Address
5 Bon Air Road, Suite 117
Larkspur, CA 94939-1138
Grant Number
H80CS00343
Participating Start Date
10/1/2001
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09656
2771 4TH ST
SANTA ROSA, CA 95405
Pharmacy Comments
Contract Details
Approval Date
4/1/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mitesh Popat, CEO
(415) 755-2581
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
4/1/2020
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