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GARFIELD BEACH CVS, L.L.C.
DSH050060 COMMUNITY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050060
Entity Address
2823 FRESNO STREET
FRESNO, CA 93721
Medicare Provider Number
050060
Participating Start Date
4/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05422
5180 E. KINGS CANYON ROAD
FRESNO, CA 93727
Pharmacy Comments
Contract Details
Approval Date
10/21/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/21/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOSEPH M. NOWICKI, CFO
(559) 324-4780
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/21/2013
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