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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09123K LA CLINICA DE LA RAZA, INC.
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Covered Entity Details
Entity Name
LA CLINICA DE LA RAZA, INC.
Subdivision Name
LA CLINICA VALLEJO
Type
HRSA-Funded Health Center
340B ID
CH09123K
Entity Address
415 GEORGIA STREET
VALLEJO, CA 94590
Grant Number
H80CS00631
Participating Start Date
7/1/2003
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09927
1193 ADMIRAL CALLAGHAN LANE
VALLEJO, CA 94591
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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