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FORTIFY MARKET
DSH050335 Sonora Community Hospital DBA Adventist Health Sonora
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Covered Entity Details
Entity Name
Sonora Community Hospital DBA Adventist Health Sonora
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050335
Entity Address
1000 Greenley Road
Sonora, CA 95370
Medicare Provider Number
050335
Participating Start Date
4/1/2017
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
FORTIFY MARKET
Pharmacy Address
ONE ADVENTIST HEALTH WAY
ROSEVILLE, CA 95661
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Greg McCulloch, President
(209) 536-5012
Contract Pharmacy Representative
Adventist Health
Mandy Kazminy, Pharmacy Manager
(916) 406-0188
Signed By Date
10/14/2022
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