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GARFIELD BEACH CVS, L.L.C.
DSH050069 ST. JOSEPH HOSPITAL OF ORANGE
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Covered Entity Details
Entity Name
ST. JOSEPH HOSPITAL OF ORANGE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050069
Entity Address
1100 WEST STEWART DRIVE
ORANGE, CA 92868
Medicare Provider Number
050069
Participating Start Date
7/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09744
1535 EAST KATELLA AVENUE
ORANGE, CA 92867
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eileen Haubl, Chief Financial Officer
(949) 364-1400 Ext: 5408
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2021
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