340B Drug Pricing Program Database

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09163
291 N MCDOWELL BLVD
PETALUMA, CA 94954

Pharmacy Comments

Approval Date

7/8/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/2/2020
Business decision by covered entity and/or pharmacy

Covered Entity Signing Official

Mich Riccioni, CFO
(707) 445-8121 Ext: 7491

Contract Pharmacy Representative

CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118

Signed By Date

7/8/2015