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EXPRESS PHARMACY
DSH050121 Adventist Medical Center
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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
EXPRESS PHARMACY
Pharmacy Address
HANFORD EXPRESS PHARMACY
365 CAMPUS DR
HANFORD, CA 93230-4374
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David L. Larsen, SR VP CFO
(559) 537-0050
Contract Pharmacy Representative
Express Pharmacy Hanford Express Pharmacy
Emad Mousad, President
(559) 583-1480
Signed By Date
7/18/2017
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