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GARFIELD BEACH CVS, L.L.C.
DSH050348 UCI MEDICAL CENTER
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Covered Entity Details
Entity Name
UCI MEDICAL CENTER
Subdivision Name
UNIVERSITY OF CALIFORNIA, IRVINE
Type
Disproportionate Share Hospital
340B ID
DSH050348
Entity Address
101 THE CITY DR. S RT32
ORANGE, CA 92868
Medicare Provider Number
050348
Participating Start Date
1/1/1998
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08862
12031 BROOKHURST STREET
GARDEN GROVE, CA 92840
Pharmacy Comments
Contract Details
Approval Date
4/16/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terry Belmont, CEO
(714) 456-6240
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
4/16/2015
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