Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050454 UCSF-MEDICAL CENTER

Covered Entity Details

Entity Name

UCSF-MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050454

Entity Address

505 PARNASSUS AVE.
SAN FRANCISCO, CA 94143

Medicare Provider Number

050454

Participating Start Date

7/1/1993

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09656
2771 4TH ST
SANTA ROSA, CA 95405

Pharmacy Comments

Contract Details

Approval Date

1/7/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/31/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

James Bennan, COO Community Hospital Division
(415) 503-8667

Contract Pharmacy Representative

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

Signed By Date

1/7/2019

340B Drug Pricing Program Database