Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CAH051315-00 TRINITY HOSPITAL

Covered Entity Details

Entity Name

TRINITY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH051315-00

Entity Address

60 EASTER AVENUE
WEAVERVILLE, CA 96093

Medicare Provider Number

051315

Participating Start Date

10/1/2014

Last Recertification Date

8/22/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09973
1595 MAIN STREET
WEAVERVILLE, CA 96093

Pharmacy Comments

Contract Details

Approval Date

10/8/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Aaron Rogers, CEO
(530) 623-2687

Contract Pharmacy Representative

CVS Caremark
JACKLYN PARFITT, MANAGER, PAYER RELATIONS
(401) 770-6467

Signed By Date

10/8/2015

340B Drug Pricing Program Database