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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050360 MARIN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MARIN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050360
Entity Address
250 BON AIR ROAD
GREENBRAE, CA 94904
Medicare Provider Number
050360
Participating Start Date
7/1/2016
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09529
442 LAS GALLINAS AVE
SAN RAFAEL, CA 94903
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James McManus, Chief Financial Officer
(415) 925-2095
Contract Pharmacy Representative
Marin General Hospital
Therese Helser, Director, Pharmacy
(415) 925-7867
Signed By Date
10/11/2018
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