Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050348 UCI MEDICAL CENTER

Covered Entity Details

Entity Name

UCI MEDICAL CENTER

Subdivision Name

UNIVERSITY OF CALIFORNIA, IRVINE

Type

Disproportionate Share Hospital

340B ID

DSH050348

Entity Address

101 THE CITY DR. S RT32
ORANGE, CA 92868

Medicare Provider Number

050348

Participating Start Date

1/1/1998

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09313
7241 BOULDER AVE
HIGHLAND, CA 92346

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Chad Thurman Lefteris, CEO
(714) 714-1423

Contract Pharmacy Representative

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

Signed By Date

10/15/2020

340B Drug Pricing Program Database