Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050067 OAK VALLEY DISTRICT HOSPITAL

Covered Entity Details

Entity Name

OAK VALLEY DISTRICT HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050067

Entity Address

350 SOUTH OAK STREET
OAKDALE, CA 95361

Medicare Provider Number

050067

Participating Start Date

4/1/2016

Last Recertification Date

8/21/2023

Entity Termination Date

10/1/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03079
2224 PATTERSON RD
RIVERBANK, CA 95367

Pharmacy Comments

Contract Details

Approval Date

4/12/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John McCormick, President and CEO
(209) 848-4102

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/12/2017

340B Drug Pricing Program Database