Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
DSH050348 UCI MEDICAL CENTER

Covered Entity Details

Entity Name

UCI MEDICAL CENTER

Subdivision Name

UNIVERSITY OF CALIFORNIA, IRVINE

Type

Disproportionate Share Hospital

340B ID

DSH050348

Entity Address

101 THE CITY DR. S RT32
ORANGE, CA 92868

Medicare Provider Number

050348

Participating Start Date

1/1/1998

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09765
312 NORTH EUCLID STREET
FULLERTON, CA 92832

Pharmacy Comments

Contract Details

Approval Date

10/17/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Richard Gannotta, Chief Executive Officer
(714) 456-7830

Contract Pharmacy Representative

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

Signed By Date

10/17/2018

340B Drug Pricing Program Database