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LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC26620-03 KOREAN HEALTH, EDUCATION, INFORMATION AND RESEARCH CENTER
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Covered Entity Details
Entity Name
KOREAN HEALTH, EDUCATION, INFORMATION AND RESEARCH CENTER
Subdivision Name
Kheir-Virgil Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26620-03
Entity Address
621 South Virgil Avenue
Suite 401
Los Angeles, CA 90005-4000
Grant Number
H80CS26620
Participating Start Date
10/1/2019
Last Recertification Date
2/3/2020
Entity Termination Date
10/1/2020
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
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Erin Pak, CEO
(213) 427-4000 Ext: 107
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/10/2020
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