Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050006 St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Covered Entity Details

Entity Name

St. Joseph Health Northern California, LLC-DBA St. Joseph Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050006

Entity Address

2700 DOLBEER STREET
EUREKA, CA 95501

Medicare Provider Number

050006

Participating Start Date

4/1/2009

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03939
800 W HARRIS ST STE 20
EUREKA, CA 95503

Pharmacy Comments

07/30/2012 added suite

Contract Details

Approval Date

6/22/2012

Contract Begin Date

6/22/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/15/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Joe Mark, President/CEO
(707) 445-8121 Ext: 7501

Contract Pharmacy Representative

CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

5/21/2012

340B Drug Pricing Program Database