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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050492 Fresno Community Hospital & Medical Center dba Clovis Community Medical Center
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Covered Entity Details
Entity Name
Fresno Community Hospital & Medical Center dba Clovis Community Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050492
Entity Address
2755 Herndon Avenue
Clovis, CA 93611
Medicare Provider Number
050492
Participating Start Date
1/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09933
1405 HERNDON AVENUE
CLOVIS, CA 93611
Pharmacy Comments
Contract Details
Approval Date
4/8/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/8/2014
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