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LONGS DRUG STORES CALIFORNIA, L.L.C.
RWI946091 Primary Care at Home, INC.
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Covered Entity Details
Entity Name
Primary Care at Home, INC.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI946091
Entity Address
400 - 29th Street
Suite 306
Oakland, CA 94609
Grant Number
H89HA00018
Participating Start Date
5/10/2021
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09884
2601 OAKDALE RD STE E
MODESTO, CA 95355
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anh T Nguyen, Board Secretary
(510) 320-2711
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/6/2023
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