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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH091940 MENDOCINO COMMUNITY HEALTH CLINIC, INC.
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Covered Entity Details
Entity Name
MENDOCINO COMMUNITY HEALTH CLINIC, INC.
Subdivision Name
Hillside Health Center
Type
HRSA-Funded Health Center
340B ID
CH091940
Entity Address
333 Laws Ave
Ukiah, CA 95482-6540
Grant Number
H80CS00628
Participating Start Date
7/1/1995
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09943
949 11TH ST
LAKEPORT, CA 95453
Pharmacy Comments
Contract Details
Approval Date
1/4/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carole Press, CEO
(707) 472-4511
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
1/4/2016
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