Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
DSH050353 PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE

Covered Entity Details

Entity Name

PROVIDENCE HEALTH SYSTEM SOUTHERN CALIFORNIA DBA PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050353

Entity Address

4101 TORRANCE BLVD.
TORRANCE, CA 90503

Medicare Provider Number

050353

Participating Start Date

4/1/2007

Last Recertification Date

8/23/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08868
5020 WEST 190TH STREET
TORRANCE, CA 90503

Pharmacy Comments

Contract Details

Approval Date

1/18/2021

Contract Begin Date

1/21/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Fleming Goeders, Chief Financial Officer
(310) 829-8411

Contract Pharmacy Representative

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

Signed By Date

1/18/2021

340B Drug Pricing Program Database