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LONGS DRUG STORES CALIFORNIA, L.L.C.
CAH051321-00 NorCal HealthConnect LLC- DBA Healdsburg Hospital
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Covered Entity Details
Entity Name
NorCal HealthConnect LLC- DBA Healdsburg Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051321-00
Entity Address
1375 UNIVERSITY AVENUE
HEALDSBURG, CA 95448
Medicare Provider Number
051321
Participating Start Date
8/23/2010
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
10/17/2024
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
10/17/2024
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