Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050225 Adventist Health Feather River

Covered Entity Details

Entity Name

Adventist Health Feather River

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050225

Entity Address

5974 PENTZ ROAD
PARADISE, CA 95969

Medicare Provider Number

050225

Participating Start Date

10/1/2010

Last Recertification Date

8/30/2018

Entity Termination Date

7/1/2019

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07506
1496 EAST AVE
CHICO, CA 95926

Pharmacy Comments

Contract Details

Approval Date

10/15/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Ryan Ashlock, CEO
(808) 263-5142

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2018

340B Drug Pricing Program Database