Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050159H VENTURA COUNTY MEDICAL CENTER

Covered Entity Details

Entity Name

VENTURA COUNTY MEDICAL CENTER

Subdivision Name

Immunology Clinic

Type

Disproportionate Share Hospital

340B ID

DSH050159H

Entity Address

300 HILLMONT AVE, BLDG #340
#503
Ventura, CA 93003

Medicare Provider Number

050159

Outpatient Facility Provider Number

Participating Start Date

1/1/1998

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