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LONGS DRUG STORES CALIFORNIA, L.L.C.
SCH050352-00 BARTON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BARTON MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH050352-00
Entity Address
2170 SOUTH AVENUE
SOUTH LAKE TAHOE, CA 96158
Medicare Provider Number
050352
Participating Start Date
7/1/2023
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09713
1043 EMERALD BAY RD
SOUTH LAKE TAHOE, CA 96150
Pharmacy Comments
Contract Details
Approval Date
4/27/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/8/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOHN G. WILLIAMS, CEO
(530) 543-5842
Contract Pharmacy Representative
CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467
Signed By Date
4/27/2015
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