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GARFIELD BEACH CVS, L.L.C.
DSH050069 ST. JOSEPH HOSPITAL OF ORANGE
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Covered Entity Details
Entity Name
ST. JOSEPH HOSPITAL OF ORANGE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050069
Entity Address
1100 WEST STEWART DRIVE
ORANGE, CA 92868
Medicare Provider Number
050069
Participating Start Date
7/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08877
671 EAST 1ST STREET
TUSTIN, CA 92780
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kristi Liberatore, Chief Financial Officer
(714) 771-8281
Contract Pharmacy Representative
John R. Zevzavadjian, Vice President, Managed Care
(401) 770-5503
Signed By Date
7/15/2014
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