Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
CHC33646-01 Korean Community Services, Inc.

Covered Entity Details

Entity Name

Korean Community Services, Inc.

Subdivision Name

KCS Health Center - Commonwealth

Type

HRSA-Funded Health Center

340B ID

CHC33646-01

Entity Address

8352 Commonwealth Ave
Buena Park, CA 90621-2526

Grant Number

H80CS33646

Participating Start Date

4/1/2021

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07079
2200 N. HARBOR BLVD. (NEC)
FULLERTON, CA 92835

Pharmacy Comments

Contract Details

Approval Date

7/13/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/31/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ellen Ahn, Executive Director
(714) 527-6561

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/13/2021

340B Drug Pricing Program Database