Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA397 Health Service Alliance

Covered Entity Details

Entity Name

Health Service Alliance

Subdivision Name

Chino Valley Community Health Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA397

Entity Address

13193 Central Ave STE 100
Chino, CA 91710

Grant Number

LALCS33333

Participating Start Date

10/1/2019

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09837
311 S MOUNTAIN AVE
UPLAND, CA 91786

Pharmacy Comments

Contract Details

Approval Date

7/15/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeff Cox, Chief Executive Officer
(909) 784-6117

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