Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CH0921760 WESTERN SIERRA MEDICAL CLINIC

Covered Entity Details

Entity Name

WESTERN SIERRA MEDICAL CLINIC

Subdivision Name

Type

HRSA-Funded Health Center

340B ID

CH0921760

Entity Address

209 NEVADA STREET
DOWNIEVILLE, CA 95936

Grant Number

H80CS08234

Participating Start Date

4/1/2007

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09155
1005 SUTTON WAY
GRASS VALLEY, CA 95945

Pharmacy Comments

Contract Details

Approval Date

10/29/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Scott McFarland, Chief Executive Officer
(530) 273-4984 Ext: 115

Contract Pharmacy Representative

CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467

Signed By Date

10/29/2015

340B Drug Pricing Program Database