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GARFIELD BEACH CVS, L.L.C.
DSH050077 SCRIPPS MERCY HOSPITAL
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Covered Entity Details
Entity Name
SCRIPPS MERCY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050077
Entity Address
4077 FIFTH AVENUE
SAN DIEGO, CA 92103
Medicare Provider Number
050077
Participating Start Date
1/1/2005
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09138
1201 E. PLAZA BLVD
NATIONAL CITY, CA 91950
Pharmacy Comments
Contract Details
Approval Date
7/8/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/26/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tom Gammiere, CEO
(619) 260-7101
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
7/8/2014
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