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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638012F Northern Valley Indian Health
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Covered Entity Details
Entity Name
Northern Valley Indian Health
Subdivision Name
Gibson Rd. Clinic
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012F
Entity Address
1280 E Gibson Rd
Woodland, CA 95776
Grant Number
Participating Start Date
10/1/2021
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09188
869 NEWVILLE RD
ORLAND, CA 95963
Pharmacy Comments
Contract Details
Approval Date
7/11/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Inder Wadhwa, CEO
(530) 896-9409
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/11/2024
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