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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH050335 Sonora Community Hospital DBA Adventist Health Sonora
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Covered Entity Details
Entity Name
Sonora Community Hospital DBA Adventist Health Sonora
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050335
Entity Address
1000 Greenley Road
Sonora, CA 95370
Medicare Provider Number
050335
Participating Start Date
4/1/2017
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09539
41 N MAIN ST
ANGELS CAMP, CA 95222
Pharmacy Comments
Contract Details
Approval Date
3/2/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Jahn, PRESIDENT/CEO
(209) 536-5012
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
3/2/2017
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