Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CH091230 LA CLINICA DE LA RAZA, INC.

Covered Entity Details

Entity Name

LA CLINICA DE LA RAZA, INC.

Subdivision Name

Type

HRSA-Funded Health Center

340B ID

CH091230

Entity Address

1450 FRUITVALE AVE,
3RD FLOOR
OAKLAND, CA 94601

Grant Number

H80CS00631

Participating Start Date

12/1/1992

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09255
931 MARINA VILLAGE PKWY
ALAMEDA, CA 94501

Pharmacy Comments

Contract Details

Approval Date

10/4/2021

Contract Begin Date

1/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/6/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Jane Garcia, CEO
(510) 535-4000

Contract Pharmacy Representative

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

Signed By Date

10/4/2021

340B Drug Pricing Program Database