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GARFIELD BEACH CVS, L.L.C.
DSH050348 UCI MEDICAL CENTER
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Covered Entity Details
Entity Name
UCI MEDICAL CENTER
Subdivision Name
UNIVERSITY OF CALIFORNIA, IRVINE
Type
Disproportionate Share Hospital
340B ID
DSH050348
Entity Address
101 THE CITY DR. S RT32
ORANGE, CA 92868
Medicare Provider Number
050348
Participating Start Date
1/1/1998
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08846
21572 PLANO TRABUCO RD.
TRABUCO CANYON, CA 92679
Pharmacy Comments
Contract Details
Approval Date
4/26/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chad Thurman Lefteris, CEO
(714) 714-1423
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/26/2023
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