Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
DSH050136 NorCal HealthConnect LLC, DBA Petaluma Valley Hospital

Covered Entity Details

Entity Name

NorCal HealthConnect LLC, DBA Petaluma Valley Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050136

Entity Address

400 N. MCDOWELL BLVD
PETALUMA, CA 94954

Medicare Provider Number

050136

Participating Start Date

4/1/2015

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16356
1980 SANTA ROSA AVE
SANTA ROSA, CA 95407

Pharmacy Comments

Contract Details

Approval Date

10/8/2024

Contract Begin Date

1/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Bharatha Naotunne, CFO
(707) 431-6523

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/8/2024

340B Drug Pricing Program Database