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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH093640 FAMILY HEALTHCARE NETWORK
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Covered Entity Details
Entity Name
FAMILY HEALTHCARE NETWORK
Subdivision Name
FAMILY HEALTHCARE NETWORK - Porterville Health Center
Type
HRSA-Funded Health Center
340B ID
CH093640
Entity Address
1107 W Poplar Ave
Porterville, CA 93257-5839
Grant Number
H80CS00786
Participating Start Date
4/1/1997
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09171
2900 STANDIFORD AVE
MODESTO, CA 95350
Pharmacy Comments
Contract Details
Approval Date
4/7/2020
Contract Begin Date
4/9/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kerry Hydash, President and CEO
(559) 737-4700
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/7/2020
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