Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050599

Entity Address

2315 STOCKTON BLVD
SACRAMENTO, CA 95817

Medicare Provider Number

050599

Participating Start Date

1/1/1999

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16294
2355 W KETTLEMAN LN
LODI, CA 95242

Pharmacy Comments

Contract Details

Approval Date

4/12/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055

Contract Pharmacy Representative

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

Signed By Date

4/12/2019

340B Drug Pricing Program Database