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GARFIELD BEACH CVS, L.L.C.
DSH050342 PIONEERS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050342
Entity Address
207 WEST LEGION ROAD
BRAWLEY, CA 92227
Medicare Provider Number
050342
Participating Start Date
9/2/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #11141
420 E 2ND ST
CALEXICO, CA 92231
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carly Loper, Chief Financial Officer
(760) 351-3594
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2024
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