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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638024 UNITED INDIAN HEALTH SERVICES
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Covered Entity Details
Entity Name
UNITED INDIAN HEALTH SERVICES
Subdivision Name
POTAWAT CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638024
Entity Address
1600 WEEOT WAY
ARCATA, CA 95521
Grant Number
Participating Start Date
1/1/1995
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
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