Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050047 SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS

Covered Entity Details

Entity Name

SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS

Subdivision Name

CALIFORNIA PACIFIC MEDICAL CENTER PACIFIC CAMPUS

Type

Disproportionate Share Hospital

340B ID

DSH050047

Entity Address

1101 VAN NESS AVE
SAN FRANCISCO, CA 94109

Medicare Provider Number

050047

Participating Start Date

4/1/2009

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09219
330 BON AIR SHOPPING CTR
GREENBRAE, CA 94904

Pharmacy Comments

Contract Details

Approval Date

10/18/2022

Contract Begin Date

11/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/27/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

HENRY YU, VP AND CFO
(415) 600-3850

Contract Pharmacy Representative

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

Signed By Date

10/18/2022

340B Drug Pricing Program Database