Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050159R VENTURA COUNTY MEDICAL CENTER

Covered Entity Details

Entity Name

VENTURA COUNTY MEDICAL CENTER

Subdivision Name

Orthopedic Clinic

Type

Disproportionate Share Hospital

340B ID

DSH050159R

Entity Address

300 HILLMONT AVE
Ventura, CA 93003

Medicare Provider Number

050159

Outpatient Facility Provider Number

Participating Start Date

1/1/1998

Last Recertification Date

8/31/2018

Entity Termination Date

10/1/2019

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09969
7850 TELEGRAPH RD
VENTURA, CA 93004

Pharmacy Comments

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