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LONGS DRUG STORES CALIFORNIA, L.L.C.
RRC050567-00 MISSION HOSPITAL REG MEDICAL CENTER
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Covered Entity Details
Entity Name
MISSION HOSPITAL REG MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC050567-00
Entity Address
27700 MEDICAL CENTER ROAD
MISSION VIEJO, CA 92691
Medicare Provider Number
050567
Participating Start Date
1/1/2021
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09242
27750 SANTA MARGARITA PKWY
MISSION VIEJO, CA 92691
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2021
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