Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
STD890121 LifeCare Partners

Covered Entity Details

Entity Name

LifeCare Partners

Subdivision Name

Dr. S. Steven Kim MDVIP

Type

Sexually Transmitted Diseases

340B ID

STD890121

Entity Address

1720 W Horizon Ridge Pkwy
#140
Henderson, NV 89012

Grant Number

NH25PS005179-05-04

Participating Start Date

7/1/2024

Last Recertification Date

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09967
1950 VILLAGE CENTER CIR
LAS VEGAS, NV 89134

Pharmacy Comments

Contract Details

Approval Date

6/12/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Vladimir Abadjiev, COO
(702) 526-3146

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/16/2024

340B Drug Pricing Program Database