Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
FQHCLA397C Health Service Alliance

Covered Entity Details

Entity Name

Health Service Alliance

Subdivision Name

Rancho Cucamonga Community Health Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA397C

Entity Address

10837 Laurel St, Ste 204
Rancho Cucamonga, CA 91730-7657

Grant Number

LALCS33333

Participating Start Date

10/1/2023

Last Recertification Date

3/6/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09837
311 S MOUNTAIN AVE
UPLAND, CA 91786

Pharmacy Comments

Contract Details

Approval Date

4/15/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Christen Grelling, Chief Operations Officer
(909) 464-9675 Ext: 104

Contract Pharmacy Representative

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

Signed By Date

4/15/2025

340B Drug Pricing Program Database