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GARFIELD BEACH CVS, L.L.C.
DSH050058 GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER
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Covered Entity Details
Entity Name
GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050058
Entity Address
1420 SOUTH CENTRAL AVE
GLENDALE, CA 91204
Medicare Provider Number
050058
Participating Start Date
1/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09614
1122 EAST BROADWAY
GLENDALE, CA 91205
Pharmacy Comments
Contract Details
Approval Date
4/9/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Allen, CFO
(818) 502-2204
Contract Pharmacy Representative
John R. Zevzavadjian, Vice President, Managed Care
(401) 770-5503
Signed By Date
4/9/2013
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