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SIERRA VISTA PHARMACY, INC.
DSH050057 Kaweah Delta Health Care District DBA Kaweah Health
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Covered Entity Details
Entity Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050057
Entity Address
400 West Mineral King Avenue
Visalia, CA 93291
Medicare Provider Number
050057
Participating Start Date
7/1/2004
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
SIERRA VISTA PHARMACY, INC.
Pharmacy Address
650 E VISALIA RD
FARMERSVILLE, CA 93223
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GARY K. HERBST, Chief Executive Officer
(559) 624-2330
Contract Pharmacy Representative
Sierra Vista Pharmacy
Feby Salem, owner
(559) 594-8602
Signed By Date
10/15/2020
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