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GARFIELD BEACH CVS, L.L.C.
DSH050047 SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
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Covered Entity Details
Entity Name
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
Subdivision Name
CALIFORNIA PACIFIC MEDICAL CENTER PACIFIC CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH050047
Entity Address
1101 VAN NESS AVE
SAN FRANCISCO, CA 94109
Medicare Provider Number
050047
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 4675
377 32ND AVENUE
SAN FRANCISCO, CA 94121
Pharmacy Comments
Contract Details
Approval Date
10/18/2022
Contract Begin Date
11/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
HENRY YU, VP AND CFO
(415) 600-3850
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/18/2022
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