Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050599

Entity Address

2315 STOCKTON BLVD
SACRAMENTO, CA 95817

Medicare Provider Number

050599

Participating Start Date

1/1/1999

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03943
5039 FOLSOM BLVD
SACRAMENTO, CA 95819

Pharmacy Comments

Contract Details

Approval Date

4/15/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055

Contract Pharmacy Representative

CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118

Signed By Date

4/15/2015

340B Drug Pricing Program Database