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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA420 COMMUNITY HEALTH CENTERS OF AMERICA
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF AMERICA
Subdivision Name
CHCA Mariposa
Type
Health Center Program Look-Alike
340B ID
FQHCLA420
Entity Address
5320 State Highway 49 N Ste 1
Mariposa, CA 95338-9588
Grant Number
LALCS40180
Participating Start Date
7/1/2024
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09992
3338 ARDEN WAY
SACRAMENTO, CA 95825
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Naresh Channaveerappa, CEO
(209) 678-0990
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2023
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