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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050133 RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
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Covered Entity Details
Entity Name
RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050133
Entity Address
726 4TH STREET
MARYSVILLE, CA 95901
Medicare Provider Number
050133
Participating Start Date
7/2/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09932
1274 STABLER LN
YUBA CITY, CA 95993
Pharmacy Comments
Contract Details
Approval Date
7/4/2018
Contract Begin Date
7/2/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/2/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Ed Gonzalez, CFO
(530) 751-4010
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/4/2018
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