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GARFIELD BEACH CVS, L.L.C.
CH09167K VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
Mobile Dental Clinic 2
Type
HRSA-Funded Health Center
340B ID
CH09167K
Entity Address
30195 Fraser Drive
Lake Elsinore, CA 92530-7006
Grant Number
H80CS00282
Participating Start Date
10/1/2017
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09104
2427 E. VALLEY PKWY
ESCONDIDO, CA 92027
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
1/12/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michele Lambert, CFO
(760) 216-5803
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2023
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