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GLENDALE URGENT CARE PHARMACY
DSH050239 GLENDALE ADVENTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
GLENDALE ADVENTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050239
Entity Address
1509 WILSON TERRACE
GLENDALE, CA 91206
Medicare Provider Number
050239
Participating Start Date
4/1/2005
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
GLENDALE URGENT CARE PHARMACY
Pharmacy Address
CENTRAL PHARMACY GROUP INC
801 S CHEVY CHASE DR STE 111
GLENDALE, CA 91205-4435
Pharmacy Comments
Contract Details
Approval Date
8/20/2012
Contract Begin Date
8/20/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/11/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rob Marchuk, VP
(818) 863-4288
Contract Pharmacy Representative
Raffi Papazian, President/CEO
(818) 502-9097
Signed By Date
7/26/2012
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