Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050159Y VENTURA COUNTY MEDICAL CENTER

Covered Entity Details

Entity Name

VENTURA COUNTY MEDICAL CENTER

Subdivision Name

Anacapa Surgical Associates/Urology Clinic

Type

Disproportionate Share Hospital

340B ID

DSH050159Y

Entity Address

300 HILLMONT AVE, BLDG #340
#401 & #402
Ventura, CA 93003

Medicare Provider Number

050159

Outpatient Facility Provider Number

Participating Start Date

4/1/2005

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09151
600 W MAIN ST
SANTA PAULA, CA 93060

Pharmacy Comments

01/27/2012 changed CP name (was LONGS DRUGS #151)

Contract Details

Approval Date

4/14/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Fankhauser, Chief Executive Officer
(805) 652-6058

Contract Pharmacy Representative

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

Signed By Date

4/14/2020

340B Drug Pricing Program Database