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LONGS DRUG STORES CALIFORNIA, L.L.C.
UI93710 Fresno American Indian Health Project
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Covered Entity Details
Entity Name
Fresno American Indian Health Project
Subdivision Name
Type
Urban Indian
340B ID
UI93710
Entity Address
1551 E. Shaw Avenue
128 & 139
Fresno, CA 93710
Grant Number
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 # 09537
1325 W SHIELDS AVENUE
FRESNO, CA 93705
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Selina De La Pena, Chief Executive Officer
(559) 320-0490
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2020
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