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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050009 ST Joseph Health Northern California LLC-DBA Queen of the Valley Medical Center
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Covered Entity Details
Entity Name
ST Joseph Health Northern California LLC-DBA Queen of the Valley Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050009
Entity Address
1000 TRANCAS STREET
NAPA, CA 94558
Medicare Provider Number
050009
Participating Start Date
4/1/2016
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07141
291 S. COOMBS ST
NAPA, CA 94559
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
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