Contract Pharmacy Details

SAVE MART PHARMACY #45
DSH050261 Sierra View Medical Center

Covered Entity Details

Entity Name

Sierra View Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050261

Entity Address

465 W PUTNAM AVENUE
PORTERVILLE, CA 93257

Medicare Provider Number

050261

Participating Start Date

7/1/2004

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

SAVE MART PHARMACY #45

Pharmacy Address

900 WEST HENDERSON
PORTERVILLE, CA 93257

Pharmacy Comments

Contract Details

Approval Date

10/21/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/13/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Donna Hefner, President/CEO
(559) 788-6100

Contract Pharmacy Representative

Robert Vaughan, Senior Director of Pharmacy Operations
(209) 574-6220

Signed By Date

10/21/2013

340B Drug Pricing Program Database