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<br /> S Pharmacy#3908 CERS ID
<br /> 885 W 11th St 10184615
<br /> racy,CA 95376
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<br /> ubmitted on 12/19/2017 by Stephen Horn of CVS Health(Woonsocket,RI)
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<br /> ongs Drug Stores California,L.L.C. Beginning Date Ending Date
<br /> Aerator Phone Business Phone Business Fax 1/1/2018 1/1/2019
<br /> 401)765-1500 (209)836-1460 (209)836-9809 Dun&Bradstreet SIC Code Primary NAICS
<br /> 001338912 5912 446110
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<br /> VS Health,Attn:Dianne E.Durand,Licensing,One CVS Drive—MC 1160 Verisk 3E
<br /> Woonsocket,R102895 Title
<br /> 4 Hour Emergency Call Center
<br /> Business Phone 24-Hour Phone Pager Number
<br /> 888)464-2960 (888)464-2960 N/A
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<br /> ongs Drug Stores California,L.L.C. harlene Adams
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<br /> ne CVS Drive tore Manager
<br /> oonsocket,RI 02895 usiness Phone 24-Hour Phone Pager Number
<br /> K209)836-1460 (209)914-2685 N/A
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<br /> VS Health,Attn:Dianne E.Durand,Licensing ferisk 3E Attn:Eric Ensminger,Regulatory Services/CVS
<br /> (401)770-3315 Dianne.Durand@CVSHealth.com 760)602-8700 Regulatory@Verisk3e.com
<br /> ne CVS Drive—MC1160 l207 Grey Hawk Ct.,Ste.200
<br /> oonsocket,RI 02895 arlsbad,CA 92010
<br /> Name of signer signer Title Document Preparer
<br /> Stephen Horn,Agent for Longs Drug Stores California,L.L.C. Regulatory Compliance Specialist,Verisk 3E Stephen Horn,Agent for Longs Drug Stores
<br /> California,L.L.C.
<br /> Additional Information
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<br /> Some or all of the following fields may be required by your local regulator(s).
<br /> Assessor Parcel Number(APN)
<br /> AR Corral Hollow,LLC 23217021
<br /> hone Number of Employees
<br /> 800)950-6333 29
<br /> Wailing Address Facility ID
<br /> 121 W.Forsyth St.,Ste.200
<br /> acksonville,FL 32202
<br /> Printed on 12/19/2017 2:03 PM
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