Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
CHC24115-04 Los Angeles Free Clinic., The

Covered Entity Details

Entity Name

Los Angeles Free Clinic., The

Subdivision Name

The Virgil

Type

HRSA-Funded Health Center

340B ID

CHC24115-04

Entity Address

137 N Virgil Ave
Los Angeles, CA 90004-4811

Grant Number

H80CS24115

Participating Start Date

7/1/2020

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08892
5822 SOUTH VERMONT AVENUE
LOS ANGELES, CA 90044

Pharmacy Comments

Contract Details

Approval Date

7/14/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/10/2021
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

7/14/2020

340B Drug Pricing Program Database