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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH091670 VISTA COMMUNITY CLINIC
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Covered Entity Details
Entity Name
VISTA COMMUNITY CLINIC
Subdivision Name
VCC: VALE TERRACE
Type
HRSA-Funded Health Center
340B ID
CH091670
Entity Address
1000 Vale Terrace Dr.
Vista, CA 92084-5218
Grant Number
H80CS00282
Participating Start Date
4/1/1996
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06368
635 S MELROSE DR
VISTA, CA 92081
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Fernando Sanudo, CEO
(760) 631-5000 Ext: 4
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2018
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