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GARFIELD BEACH CVS, L.L.C.
CH0933070 ST. VINCENT DE PAUL VILLAGE, INC.
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Covered Entity Details
Entity Name
ST. VINCENT DE PAUL VILLAGE, INC.
Subdivision Name
Village Health Center
Type
HRSA-Funded Health Center
340B ID
CH0933070
Entity Address
16 15th St
San Diego, CA 92101
Grant Number
H80CS10606
Participating Start Date
9/5/2008
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09138
1201 E. PLAZA BLVD
NATIONAL CITY, CA 91950
Pharmacy Comments
Contract Details
Approval Date
10/4/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeffrey Norris, CMO
(619) 645-6422
Contract Pharmacy Representative
CVS
Derek Stearns, National Sales Executive
(503) 317-9840
Signed By Date
10/4/2021
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