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DELANO FAMILY PHARMACY
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
DELANO FAMILY PHARMACY
Pharmacy Address
1401 GARCES HWY BLDG A
DELANO, CA 93215-3699
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/6/2024
Ownership change
Contacts
Covered Entity Signing Official
Shane H Cox, Finance Officer
(661) 869-6180
Contract Pharmacy Representative
Adventist Health Delano
Terrance Monrian, Director, Pharmacy
(661) 721-5616
Signed By Date
1/13/2022
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