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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09071S COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.
Subdivision Name
COMMUNITY HEALTH CENTERS SAN LUIS OBISPO
Type
HRSA-Funded Health Center
340B ID
CH09071S
Entity Address
1551 BISHOP ST.
SAN LUIS OBISPO, CA 93401-4635
Grant Number
H80CS00621
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2015
Entity Termination Date
4/1/2016
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09345
717 MARSH ST
SAN LUIS OBISPO, CA 93401
Pharmacy Comments
Contract Details
Approval Date
12/4/2009
Contract Begin Date
12/4/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
RONALD E. CASTLE, CEO
(805) 459-1835
Contract Pharmacy Representative
DEBORAH VEALE, DIRECTOR MANAGED CARE
(310) 544-6658
Signed By Date
11/30/2009
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