Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050195 WASHINGTON HOSPITAL HEALTHCARE SYSTEM

Covered Entity Details

Entity Name

WASHINGTON HOSPITAL HEALTHCARE SYSTEM

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050195

Entity Address

2000 MOWRY AVENUE
FREMONT, CA 94538

Medicare Provider Number

050195

Participating Start Date

7/1/2010

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00331
2000 DRISCOLL RD
FREMONT, CA 94539

Pharmacy Comments

Contract Details

Approval Date

10/14/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/5/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Edward Fayen, Exec VP & Chief of Operations
(510) 818-6513

Contract Pharmacy Representative

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

Signed By Date

10/14/2022

340B Drug Pricing Program Database