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LONGS DRUG STORES CALIFORNIA, L.L.C.
CHC28981-02 WESTERN SIERRA MEDICAL CLINIC, INC.
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Covered Entity Details
Entity Name
WESTERN SIERRA MEDICAL CLINIC, INC.
Subdivision Name
Searls Avenue
Type
HRSA-Funded Health Center
340B ID
CHC28981-02
Entity Address
590 Searls Ave
Nevada City, CA 95959-3043
Grant Number
H80CS08234
Participating Start Date
1/1/2024
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09155
1005 SUTTON WAY
GRASS VALLEY, CA 95945
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jenny Lawson, Administration
(530) 292-3478 Ext: 223
Contract Pharmacy Representative
CVS
Erica Short, Account Manager
(480) 364-1195
Signed By Date
10/16/2023
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