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GARFIELD BEACH CVS, L.L.C.
DSH050100 SHARP MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHARP MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050100
Entity Address
7901 FROST STREET
SAN DIEGO, CA 92123
Medicare Provider Number
050100
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09165
3327 ROSECRANS ST.
SAN DIEGO, CA 92110
Pharmacy Comments
Contract Details
Approval Date
3/8/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Thompson, Chief Financial Officer
(858) 939-3884
Contract Pharmacy Representative
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
1/15/2013
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