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GARFIELD BEACH CVS, L.L.C.
DSH050067 OAK VALLEY DISTRICT HOSPITAL
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Covered Entity Details
Entity Name
OAK VALLEY DISTRICT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050067
Entity Address
350 SOUTH OAK STREET
OAKDALE, CA 95361
Medicare Provider Number
050067
Participating Start Date
4/1/2016
Last Recertification Date
8/21/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16082
3405 MCHENRY AVE
MODESTO, CA 95350
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ann Croskrey, CFO
(209) 848-4104
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/13/2021
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