Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
STD95422 PLANNED PARENTHOOD SHASTA-DIABLO, INC. DBA PLANNED PARENTHOOD NORTHERN CALIFORNIA

Covered Entity Details

Entity Name

PLANNED PARENTHOOD SHASTA-DIABLO, INC. DBA PLANNED PARENTHOOD NORTHERN CALIFORNIA

Subdivision Name

CLEARLAKE CENTER

Type

Sexually Transmitted Diseases

340B ID

STD95422

Entity Address

14671 OLYMPIC DR.
CLEARLAKE, CA 95422

Grant Number

1H25PS005127

Participating Start Date

7/1/2014

Last Recertification Date

5/21/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09948
2700 YULUPA AVE
SANTA ROSA, CA 95405

Pharmacy Comments

Contract Details

Approval Date

9/2/2022

Contract Begin Date

9/12/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gloria Martinez, Medical Services & Purchasing Manager
(925) 887-5217

Contract Pharmacy Representative

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

Signed By Date

9/2/2022

340B Drug Pricing Program Database