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GARFIELD BEACH CVS, L.L.C.
FQHCLA397 Health Service Alliance
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Covered Entity Details
Entity Name
Health Service Alliance
Subdivision Name
Chino Valley Community Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA397
Entity Address
13193 Central Ave STE 100
Chino, CA 91710
Grant Number
LALCS33333
Participating Start Date
10/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #10914
8956 FOOTHILL BLVD
RANCHO CUCAMONGA, CA 91730
Pharmacy Comments
Contract Details
Approval Date
7/16/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Cox, Chief Executive Officer
(909) 784-6117
Contract Pharmacy Representative
CVSHEALTH
ADAM J HORN, ACCOUNT MGR
(773) 610-9315
Signed By Date
7/16/2024
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