Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050394 CMH OF SAN BUENAVENTURA

Covered Entity Details

Entity Name

CMH OF SAN BUENAVENTURA

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050394

Entity Address

147 N. BRENT STREET
VENTURA, CA 93003

Medicare Provider Number

050394

Participating Start Date

10/1/2019

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09236
50 N ASHWOOD AVE
VENTURA, CA 93003

Pharmacy Comments

01/27/2012 changed CP name (was LONGS DRUGS #236)

Contract Details

Approval Date

10/15/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DAVID BURRIS GLYER, cfo
(805) 652-5003

Contract Pharmacy Representative

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

Signed By Date

10/15/2019

340B Drug Pricing Program Database