Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050006 St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Covered Entity Details

Entity Name

St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050006

Entity Address

2700 DOLBEER STREET
EUREKA, CA 95501

Medicare Provider Number

050006

Participating Start Date

4/1/2009

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09681
1105 MYRTLE AVE
EUREKA, CA 95501

Pharmacy Comments

Contract Details

Approval Date

1/25/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Patti Pilgrim, Regional CFO
(707) 525-5323

Contract Pharmacy Representative

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

Signed By Date

1/25/2021

340B Drug Pricing Program Database