Contract Pharmacy Details

FOX DRUG STORE
DSH050121 Adventist Medical Center

Covered Entity Details

Entity Name

Adventist Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050121

Entity Address

115 mall drive
HANFORD, CA 93230

Medicare Provider Number

050121

Participating Start Date

1/1/2008

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

FOX DRUG STORE

Pharmacy Address

13660 E MANNING AVE STE 102
PARLIER, CA 93648-9743

Pharmacy Comments

Contract Details

Approval Date

4/15/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Wayne Ferch, President & CEO
(559) 537-0053

Contract Pharmacy Representative

Sunnyside Pharmacy
Lunny Jung, CEO
(213) 590-2375

Signed By Date

4/15/2013