340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
KMART PHARMACY #4705
DSH050196 Central Valley General Hospital
Print
Covered Entity Details
Entity Name
Central Valley General Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050196
Entity Address
1025 N. Douty Street
Hanford, CA 93230
Medicare Provider Number
050196
Participating Start Date
1/1/2008
Last Recertification Date
8/17/2016
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
KMART PHARMACY #4705
Pharmacy Address
333 SIERRA
KINGSBURG, CA 93631
Pharmacy Comments
Contract Details
Approval Date
3/11/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
David L. Larsen, SR VP CFO
(559) 537-0050
Contract Pharmacy Representative
Ghassan Hourani, VP/GMM Pharmacy Administration
(847) 286-3382
Signed By Date
1/8/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session