Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, LLC
CH092420 OLE HEALTH

Covered Entity Details

Entity Name

OLE HEALTH

Subdivision Name

OLE Health - North Napa Campus

Type

HRSA-Funded Health Center

340B ID

CH092420

Entity Address

1141 PEAR TREE LANE
Suite 100
NAPA, CA 94558-6485

Grant Number

H80CS04219

Participating Start Date

10/1/2004

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, LLC

Pharmacy Address

D.B.A. CVS DISTRIBUTION CENTER
2400 KEYSTONE PACIFIC PKWY
SUITE B
PATTERSON, CA 95363

Pharmacy Comments

Contract Details

Approval Date

10/9/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/12/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tanir Ami, Chief Executive Officer
(707) 254-1770 Ext: 214

Contract Pharmacy Representative

CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241

Signed By Date

10/9/2014

340B Drug Pricing Program Database