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GARFIELD BEACH CVS, L.L.C.
DSH050093 SAINT AGNES MEDICAL CENTER
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Covered Entity Details
Entity Name
SAINT AGNES MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050093
Entity Address
1303 E HERNDON AVE
FRESNO, CA 93720
Medicare Provider Number
050093
Participating Start Date
1/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16084
3150 W SHAW AVE
FRESNO, CA 93711
Pharmacy Comments
Contract Details
Approval Date
1/12/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NANCY HOLLINGSWORTH, CEO
(559) 450-3301
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2022
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