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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050159AB VENTURA COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
VENTURA COUNTY MEDICAL CENTER
Subdivision Name
Pediatric Hematology-Oncology Clinic
Type
Disproportionate Share Hospital
340B ID
DSH050159AB
Entity Address
300 HILLMONT AVE, BLDG #340
#301
Ventura, CA 93003
Medicare Provider Number
050159
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09236
50 N ASHWOOD AVE
VENTURA, CA 93003
Pharmacy Comments
01/27/2012 changed CP name (was LONGS DRUGS #236)
Contract Details
Approval Date
10/19/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathleen Kellerhouse, Chief of Hospital Operations
(805) 652-6052
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/19/2015
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