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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09123M LA CLINICA DE LA RAZA, INC.
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Covered Entity Details
Entity Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
Hawthorne Elementary School-Based Clinic
Type
HRSA-Funded Health Center
340B ID
CH09123M
Entity Address
1700 28th Avenue
Oakland, CA 94601-2455
Grant Number
H80CS00631
Participating Start Date
4/1/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09226
3320 FRUITVALE AVE
OAKLAND, CA 94602
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jane Garcia, CEO
(510) 535-4000
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/4/2023
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