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TARGET STORES A DIV.OF TARGET CORP.
CH091963G LIVINGSTON COMMUNITY HEALTH
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Covered Entity Details
Entity Name
LIVINGSTON COMMUNITY HEALTH
Subdivision Name
Livingston Community Health Campus, B Street, Buildings A, B, C
Type
HRSA-Funded Health Center
340B ID
CH091963G
Entity Address
600 B Street BLDG A, B, C
Livingston, CA 95334-9593
Grant Number
H80CS02588
Participating Start Date
7/1/2019
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
TARGET STORES A DIV.OF TARGET CORP.
Pharmacy Address
TARGET STORE T-1304
ATTN: PHARMACY
3000 COUNTRYSIDE DRIVE
TURLOCK, CA 95380
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
4/23/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/23/2021
Duplicate contract pharmacy record
Contacts
Covered Entity Signing Official
Leslie Abasta-Cummings, CEO
(209) 850-3545
Contract Pharmacy Representative
Welllpartner
Kristen Hartlen, Sr. Account Manager
(480) 364-2573
Signed By Date
4/13/2021
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