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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050280 MERCY MEDICAL CENTER, REDDING
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER, REDDING
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050280
Entity Address
2175 ROSALINE AVENUE
REDDING, CA 96001-6009
Medicare Provider Number
050280
Participating Start Date
4/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03911
1060 E CYPRESS AVE
REDDING, CA 96002
Pharmacy Comments
Contract Details
Approval Date
12/12/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/27/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tim Panks, Chief Financial Officer
(530) 225-6121
Contract Pharmacy Representative
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
10/12/2012
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