Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050159E VENTURA COUNTY MEDICAL CENTER

Covered Entity Details

Entity Name

VENTURA COUNTY MEDICAL CENTER

Subdivision Name

Medicine Specialty Center-West

Type

Disproportionate Share Hospital

340B ID

DSH050159E

Entity Address

300 HILLMONT AVE, BLDG #340
#502
Ventura, CA 93003

Medicare Provider Number

050159

Outpatient Facility Provider Number

Participating Start Date

1/1/1998

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09236
50 N ASHWOOD AVE
VENTURA, CA 93003

Pharmacy Comments

01/27/2012 changed CP name (was LONGS DRUGS #236)

Contract Details

Approval Date

10/19/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/15/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kathleen Kellerhouse, Chief of Hospital Operations
(805) 652-6052

Contract Pharmacy Representative

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

Signed By Date

10/19/2015

340B Drug Pricing Program Database