Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050159U Ventura County Medical Center

Covered Entity Details

Entity Name

Ventura County Medical Center

Subdivision Name

Ventura County Mental Health

Type

Disproportionate Share Hospital

340B ID

DSH050159U

Entity Address

200 Hillmont Ave.
Ventura, CA 93003

Medicare Provider Number

050159

Outpatient Facility Provider Number

Participating Start Date

4/1/2005

Last Recertification Date

9/5/2016

Entity Termination Date

10/1/2016

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

10/1/2016

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