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EL TEJON DRUGS
DSH050455 Adventist Health Bakersfield
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Covered Entity Details
Entity Name
Adventist Health Bakersfield
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050455
Entity Address
2615 Chester Avenue
BAKERSFIELD, CA 93301
Medicare Provider Number
050455
Participating Start Date
4/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
EL TEJON DRUGS
Pharmacy Address
2819 N CHESTER AVE
BAKERSFIELD, CA 93308
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas Duffield, CEO
(661) 869-6180
Contract Pharmacy Representative
El Tejon Drug
Ty Stout, Vice President
(661) 399-2901
Signed By Date
4/15/2014
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