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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050136 NorCal HealthConnect LLC, DBA Petaluma Valley Hospital
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Covered Entity Details
Entity Name
NorCal HealthConnect LLC, DBA Petaluma Valley Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050136
Entity Address
400 N. MCDOWELL BLVD
PETALUMA, CA 94954
Medicare Provider Number
050136
Participating Start Date
4/1/2015
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09946
463 STONY POINT RD
SANTA ROSA, CA 95401
Pharmacy Comments
Contract Details
Approval Date
10/8/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bharatha Naotunne, CFO
(707) 431-6523
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/8/2024
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