Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
DSH050438 HUNTINGTON HOSPITAL

Covered Entity Details

Entity Name

HUNTINGTON HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050438

Entity Address

100 W. California Blvd
Pasadena, CA 91105

Medicare Provider Number

050438

Participating Start Date

7/1/2019

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01778
3883 E. FOOTHILL BLVD (NWC)
PASADENA, CA 91107

Pharmacy Comments

Contract Details

Approval Date

7/20/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Steven Mohr, Senior Vice President & Chief Financial Officer
(626) 397-5555

Contract Pharmacy Representative

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

Signed By Date

7/20/2021

340B Drug Pricing Program Database