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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050159AB VENTURA COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
VENTURA COUNTY MEDICAL CENTER
Subdivision Name
Pediatric Hematology-Oncology Clinic
Type
Disproportionate Share Hospital
340B ID
DSH050159AB
Entity Address
300 HILLMONT AVE, BLDG #340
#301
Ventura, CA 93003
Medicare Provider Number
050159
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
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
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