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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050192 Reedley Community Hospital dba Adventist Health Reedley
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Covered Entity Details
Entity Name
Reedley Community Hospital dba Adventist Health Reedley
Subdivision Name
Reedley Community Hospital
Type
Disproportionate Share Hospital
340B ID
DSH050192
Entity Address
372 W. Cypress Ave
Reedley, CA 93654
Medicare Provider Number
050192
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09710
111 E MERCED ST
FOWLER, CA 93625
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/24/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
David L. Larsen, SR VP CFO
(559) 537-0050
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
10/17/2016
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