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UNIVERSITY MEDICAL CENTER PHARMACY
DSH050060 COMMUNITY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050060
Entity Address
2823 FRESNO STREET
FRESNO, CA 93721
Medicare Provider Number
050060
Participating Start Date
4/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY MEDICAL CENTER PHARMACY
Pharmacy Address
290 N WAYTE LN FL 1
FRESNO, CA 93701-2124
Pharmacy Comments
Contract Details
Approval Date
7/2/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Contract Pharmacy Representative
University Medical Center Pharmacy
Scott Evans, Pharmacy Manager
(559) 459-3578
Signed By Date
7/2/2020
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