Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
PED053303-00 RADY CHILDRENS HOSPITAL - SAN DIEGO

Covered Entity Details

Entity Name

RADY CHILDRENS HOSPITAL - SAN DIEGO

Subdivision Name

Type

Children's Hospital

340B ID

PED053303-00

Entity Address

3020 Children's Way
San Diego, CA 92123-4282

Medicare Provider Number

053303

Participating Start Date

1/1/2015

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07127
1302 WEST MISSION RD.
SAN MARCOS, CA 92069

Pharmacy Comments

Contract Details

Approval Date

4/15/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Charles Brendan Davis, Interim Chief Operating Officer
(858) 966-4001

Contract Pharmacy Representative

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

Signed By Date

4/15/2025

340B Drug Pricing Program Database