Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC24115-03 Los Angeles Free Clinic., The

Covered Entity Details

Entity Name

Los Angeles Free Clinic., The

Subdivision Name

The Center at Blessed Sacrament

Type

HRSA-Funded Health Center

340B ID

CHC24115-03

Entity Address

6636 Selma Ave
Los Angeles, CA 90028-7115

Grant Number

H80CS24115

Participating Start Date

4/1/2020

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

4/9/2020

Contract Begin Date

7/1/2020

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

4/9/2020

340B Drug Pricing Program Database