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RALEY'S PHARMACY #106
DSH290001 RENOWN REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RENOWN REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH290001
Entity Address
1155 MILL STREET
RENO, NV 89502-1474
Medicare Provider Number
290001
Participating Start Date
4/1/2009
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
RALEY'S PHARMACY #106
Pharmacy Address
701 KEYSTONE AVENUE
RENO, NV 89503
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/17/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Ann Beck, CFO Acute Care
(775) 982-6488
Contract Pharmacy Representative
Raley's
Cindy Fong, Director of Pharmacy
(916) 373-6411
Signed By Date
7/9/2020
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