Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
DSH050262 RONALD REAGAN UCLA MEDICAL CENTER

Covered Entity Details

Entity Name

RONALD REAGAN UCLA MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050262

Entity Address

757 WESTWOOD PLAZA
LOS ANGELES, CA 90095

Medicare Provider Number

050262

Participating Start Date

1/1/1998

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09573
6299 SOUTH BRISTOL PARKWAY
CULVER CITY, CA 90230

Pharmacy Comments

Contract Details

Approval Date

10/11/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/29/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Paul Staton, CFO
(310) 267-9308

Contract Pharmacy Representative

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

Signed By Date

10/11/2018

340B Drug Pricing Program Database