Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHC638012F Northern Valley Indian Health

Covered Entity Details

Entity Name

Northern Valley Indian Health

Subdivision Name

Gibson Rd

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 # 09180
7 W MAIN ST
WOODLAND, CA 95695

Pharmacy Comments

Contract Details

Approval Date

1/13/2025

Contract Begin Date

4/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Inder Wadhwa, CEO
(530) 896-9409

Contract Pharmacy Representative

Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118

Signed By Date

1/13/2025

340B Drug Pricing Program Database