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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050099 SAN ANTONIO REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
SAN ANTONIO REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050099
Entity Address
999 SAN BERNARDINO ROAD
UPLAND, CA 91786
Medicare Provider Number
050099
Participating Start Date
1/1/2018
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09910
3440 LA SIERRA AVE
RIVERSIDE, CA 92503
Pharmacy Comments
Contract Details
Approval Date
7/12/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peter Aprato, Compliance Officer
(909) 694-1098
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2020
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