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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050396 SANTA BARBARA COTTAGE HOSPITAL
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Covered Entity Details
Entity Name
SANTA BARBARA COTTAGE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050396
Entity Address
400 WEST PUEBLO STREET
SANTA BARBARA, CA 93105
Medicare Provider Number
050396
Participating Start Date
4/1/2017
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09592
1435 E GRAND AVE
ARROYO GRANDE, CA 93420
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brett Tande, Senior Vice President of Finance
(805) 569-7294
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2021
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