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LONGS DRUG STORES CALIFORNIA, L.L.C.
CAH051315-00 TRINITY HOSPITAL
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Covered Entity Details
Entity Name
TRINITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051315-00
Entity Address
60 EASTER AVENUE
WEAVERVILLE, CA 96093
Medicare Provider Number
051315
Participating Start Date
10/1/2014
Last Recertification Date
8/22/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09147
2605 WEST MARCH LANE
STOCKTON, CA 95207
Pharmacy Comments
Contract Details
Approval Date
4/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Van Matre, Chief Financial Officer
(530) 623-5541 Ext: 3232
Contract Pharmacy Representative
Wellpartner, a CVS Health Company
Alyssa Felton, Consultant, Account Manager
(480) 586-7265
Signed By Date
4/6/2020
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