Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CAH051311-00 ORCHARD HOSPITAL

Covered Entity Details

Entity Name

ORCHARD HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH051311-00

Entity Address

240 SPRUCE ST.
GRIDLEY, CA 95948

Medicare Provider Number

051311

Participating Start Date

1/1/2011

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09525
260 SPRUCE ST
GRIDLEY, CA 95948

Pharmacy Comments

Contract Details

Approval Date

4/15/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Tracy Atkins, COO
(530) 846-5671

Contract Pharmacy Representative

Orchard Hospital
Matt Washburn, 340B Program Manager
(530) 846-9064

Signed By Date

4/15/2014

340B Drug Pricing Program Database