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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050254 MARSHALL HOSPITAL
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Covered Entity Details
Entity Name
MARSHALL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050254
Entity Address
1100 MARSHALL WAY
PLACERVILLE, CA 95667
Medicare Provider Number
050254
Participating Start Date
1/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09823
1350 FLORIN ROAD
SACRAMENTO, CA 95822
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
11/27/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
James Whipple, Chief Executive Officer
(530) 626-2601
Contract Pharmacy Representative
Marshall med Ctr
Bob DiPonti, Director of Pharmacy
(530) 626-2657
Signed By Date
10/15/2018
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