Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638024A UNITED INDIAN HEALTH SERVICES

Covered Entity Details

Entity Name

UNITED INDIAN HEALTH SERVICES

Subdivision Name

Crescent City Medical Clinic

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638024A

Entity Address

1675 Northcrest Drive
Crescent City, CA 95531

Grant Number

Participating Start Date

1/1/2009

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03939
800 W HARRIS ST STE 20
EUREKA, CA 95503

Pharmacy Comments

07/30/2012 added suite

Contract Details

Approval Date

7/14/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jedediah Rudd, Chief Operating Officer
(707) 825-4049

Contract Pharmacy Representative

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

Signed By Date

7/14/2021

340B Drug Pricing Program Database