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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA328 SAN JOAQUIN, COUNTY OF
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Covered Entity Details
Entity Name
SAN JOAQUIN, COUNTY OF
Subdivision Name
Primary Medicine Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA328
Entity Address
500 W. Hospital Rd
Suite C
French Camp, CA 95231-9693
Grant Number
LALCS00158
Participating Start Date
10/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09866
1190 N MAIN ST
MANTECA, CA 95336
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Farhan Fadoo, Chief Executive Officer
(209) 953-3700
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2023
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