Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050013 St. Helena Hospital, DBA Adventist Health St. Helena

Covered Entity Details

Entity Name

St. Helena Hospital, DBA Adventist Health St. Helena

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050013

Entity Address

10 WOODLAND ROAD
ST. HELENA, CA 94574

Medicare Provider Number

050013

Participating Start Date

4/1/2010

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01804
675 TRANCAS ST
NAPA, CA 94558

Pharmacy Comments

Contract Details

Approval Date

10/18/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Steven Herber, CEO
(707) 963-6433

Contract Pharmacy Representative

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

Signed By Date

10/18/2018

340B Drug Pricing Program Database