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LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA469 LYON-MARTIN COMMUNITY HEALTH SERVICES
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Covered Entity Details
Entity Name
LYON-MARTIN COMMUNITY HEALTH SERVICES
Subdivision Name
Lyon-Martin Community Health Services
Type
Health Center Program Look-Alike
340B ID
FQHCLA469
Entity Address
1735 Mission St
San Francisco, CA 94103-2417
Grant Number
LALCS53018
Participating Start Date
10/1/2024
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09253
560 CENTER AVE
MARTINEZ, CA 94553
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jackson James Miller Jaffe, CEO
(415) 901-7108
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2024
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