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LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC24113-00 Elica Health Centers
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Covered Entity Details
Entity Name
Elica Health Centers
Subdivision Name
Elica Health Centers
Type
HRSA-Funded Health Center
340B ID
CHC24113-00
Entity Address
155 15th St
West Sacramento, CA 95691
Grant Number
H80CS24113
Participating Start Date
1/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09487
8861 GREENBACK LN
ORANGEVALE, CA 95662
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
David E Hughes, COO/CFO
(916) 569-8484 Ext: 312
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/8/2021
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