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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH091600 Omni Family Health
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Covered Entity Details
Entity Name
Omni Family Health
Subdivision Name
Omni Family Health
Type
HRSA-Funded Health Center
340B ID
CH091600
Entity Address
277 East Front Street
Buttonwillow, CA 93206
Grant Number
H80CS00615
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09204
3500 STINE RD
BAKERSFIELD, CA 93309
Pharmacy Comments
Contract Details
Approval Date
10/11/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/18/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Diego Martinez, Chief Operations Officer
(661) 630-7030
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/11/2017
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