Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050599

Entity Address

2315 STOCKTON BLVD
SACRAMENTO, CA 95817

Medicare Provider Number

050599

Participating Start Date

1/1/1999

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09487
8861 GREENBACK LN
ORANGEVALE, CA 95662

Pharmacy Comments

Contract Details

Approval Date

7/5/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/18/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Cheryl Ann Sadro, Chief Financial Officer
(916) 703-5009

Contract Pharmacy Representative

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

Signed By Date

7/5/2022

340B Drug Pricing Program Database