Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638024E United Indian Health Service

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

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09681
1105 MYRTLE AVE
EUREKA, CA 95501

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

340B Drug Pricing Program Database