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LODI MEMORIAL HOSPITAL ASSOCIATION, INC.
DSH050455 Adventist Health Bakersfield
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Covered Entity Details
Entity Name
Adventist Health Bakersfield
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050455
Entity Address
2615 Chester Avenue
BAKERSFIELD, CA 93301
Medicare Provider Number
050455
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
LODI MEMORIAL HOSPITAL ASSOCIATION, INC.
Pharmacy Address
DBA ADVENTIST HEALTH LODI MEMORIAL
975 S FAIRMONT AVE
LODI, CA 95240
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Shane H Cox, Finance Officer
(661) 869-6180
Contract Pharmacy Representative
Adventist Health Lodi Memorial
Sandy Beck Atwater, Pharmacy Director
(209) 339-7555
Signed By Date
10/11/2021
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