Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050254 MARSHALL HOSPITAL

Covered Entity Details

Entity Name

MARSHALL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050254

Entity Address

1100 MARSHALL WAY
PLACERVILLE, CA 95667

Medicare Provider Number

050254

Participating Start Date

1/1/2016

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03950
2790 E BIDWELL ST
FOLSOM, CA 95630

Pharmacy Comments

Contract Details

Approval Date

4/13/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Siri Nelson, CEO
(707) 349-8127

Contract Pharmacy Representative

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

Signed By Date

4/13/2023

340B Drug Pricing Program Database