340B Drug Pricing Program Database
FOX DRUG STORE
DSH050196 Central Valley General Hospital - information as of 4/24/2025 11:28:25 PM
Covered Entity Details
Entity Name
Central Valley General Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050196
Entity Address
1025 N. Douty Street
Hanford, CA 93230
Medicare Provider Number
050196
Participating Start Date
1/1/2008
Last Recertification Date
8/17/2016
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
FOX DRUG STORE
Pharmacy Address
1939 HIGH ST
SELMA, CA 93662-3510
Pharmacy Comments
Contract Details
Approval Date
10/11/2012
Contract Begin Date
10/11/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
David L. Larsen, Senior VP & CFO
(559) 537-0053
Contract Pharmacy Representative
Sunnyside Pharmacy
Lunny Jung, CEO
(213) 590-2375
Signed By Date
9/17/2012
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