Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050454 UCSF-MEDICAL CENTER

Covered Entity Details

Entity Name

UCSF-MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050454

Entity Address

505 PARNASSUS AVE.
SAN FRANCISCO, CA 94143

Medicare Provider Number

050454

Participating Start Date

7/1/1993

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07955
2025 VAN NESS AVE
SAN FRANCISCO, CA 94109

Pharmacy Comments

Contract Details

Approval Date

4/14/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/7/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

MARK LARET, CEO
(415) 353-2733

Contract Pharmacy Representative

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

Signed By Date

4/14/2015

340B Drug Pricing Program Database