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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638032 URBAN INDIAN HEALTH BOARD
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Covered Entity Details
Entity Name
URBAN INDIAN HEALTH BOARD
Subdivision Name
DBA NATIVE AMERICAN HEALTH CENTER
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638032
Entity Address
2950 International Blvd.
OAKLAND, CA 94601
Grant Number
Participating Start Date
1/1/1995
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09378
4100 REDWOOD RD
OAKLAND, CA 94619
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greg C Garrett, Chief Operating Officer
(510) 485-5902
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2022
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