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GARFIELD BEACH CVS, L.L.C.
FQHC638024E United Indian Health Service
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Covered Entity Details
Entity Name
United Indian Health Service
Subdivision Name
Smith River Clinic
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638024E
Entity Address
501 North Indian Rd
Smith River, CA 95567
Grant Number
Participating Start Date
1/1/2017
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #10478
657 US HIGHWAY 101 N.
CRESCENT CITY, CA 95531
Pharmacy Comments
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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