Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC24115-05 Los Angeles Free Clinic., The

Covered Entity Details

Entity Name

Los Angeles Free Clinic., The

Subdivision Name

Saban Community Clinic - Mobile Clinic Site

Type

HRSA-Funded Health Center

340B ID

CHC24115-05

Entity Address

6043 Hollywood Blvd.
Los Angeles, CA 90028

Grant Number

H80CS24115

Participating Start Date

10/1/2022

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09144
7021 HOLLYWOOD BLVD
LOS ANGELES, CA 90028

Pharmacy Comments

Contract Details

Approval Date

7/15/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Muriel Nouwezem, CEO
(323) 337-1707

Contract Pharmacy Representative

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

Signed By Date

7/15/2022

340B Drug Pricing Program Database