Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
RWI946091 Primary Care at Home, INC.

Covered Entity Details

Entity Name

Primary Care at Home, INC.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI946091

Entity Address

400 - 29th Street
Suite 306
Oakland, CA 94609

Grant Number

H89HA00018

Participating Start Date

5/10/2021

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09248
1700 MCHENRY AVE.
MODESTO, CA 95350

Pharmacy Comments

Contract Details

Approval Date

1/15/2025

Contract Begin Date

4/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Anh T Nguyen, Board Secretary
(510) 320-2711

Contract Pharmacy Representative

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

Signed By Date

1/15/2025

340B Drug Pricing Program Database