Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050315 KERN MEDICAL CENTER

Covered Entity Details

Entity Name

KERN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050315

Entity Address

1700 MT. VERNON AVE.
BAKERSFIELD, CA 93306

Medicare Provider Number

050315

Participating Start Date

10/1/1995

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09900
2690 MOUNT VERNON AVE
BAKERSFIELD, CA 93306

Pharmacy Comments

Contract Details

Approval Date

7/16/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/16/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Russell Judd, CEO
(661) 326-2095

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/16/2016

340B Drug Pricing Program Database