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GARFIELD BEACH CVS, L.L.C.
DSH050238 USC ARCADIA HOSPITAL
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Covered Entity Details
Entity Name
USC ARCADIA HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050238
Entity Address
300 WEST HUNTINGTON DRIVE
ARCADIA, CA 91007
Medicare Provider Number
050238
Participating Start Date
10/1/2006
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09721
1401 S. BALDWIN AVE.
ARCADIA, CA 91007
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Ausman, CEO and President
(626) 574-3600
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2019
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