Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CH090710 COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC.

Subdivision Name

NIPOMO COMMUNITY MEDICAL CENTER

Type

HRSA-Funded Health Center

340B ID

CH090710

Entity Address

150 TEJAS PL
NIPOMO, CA 93444-9123

Grant Number

H80CS00621

Participating Start Date

4/1/1996

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09892
827 OAK PARK BLVD
PISMO BEACH, CA 93449

Pharmacy Comments

Contract Details

Approval Date

10/3/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

RONALD E. CASTLE, CEO
(805) 459-1835

Contract Pharmacy Representative

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

Signed By Date

10/3/2013

340B Drug Pricing Program Database