Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050093 SAINT AGNES MEDICAL CENTER

Covered Entity Details

Entity Name

SAINT AGNES MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050093

Entity Address

1303 E HERNDON AVE
FRESNO, CA 93720

Medicare Provider Number

050093

Participating Start Date

1/1/2014

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09971
4077 W CLINTON AVE
FRESNO, CA 93722

Pharmacy Comments

Contract Details

Approval Date

1/12/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

NANCY HOLLINGSWORTH, CEO
(559) 450-3301

Contract Pharmacy Representative

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

Signed By Date

1/12/2022

340B Drug Pricing Program Database