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GROVELAND PHARMACY
CAH051304-00 JOHN C. FREMONT HEALTHCARE DISTRICT
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Covered Entity Details
Entity Name
JOHN C. FREMONT HEALTHCARE DISTRICT
Subdivision Name
A POLITICAL SUBDIVISION OF THE STATE OF CALIFORNIA
Type
Critical Access Hospital
340B ID
CAH051304-00
Entity Address
5189 HOSPITAL RD
MARIPOSA, CA 95338-0216
Medicare Provider Number
051304
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
GROVELAND PHARMACY
Pharmacy Address
18638 MAIN ST
P.O. BOX 809
GROVELAND, CA 95321-9432
Pharmacy Comments
Contract Details
Approval Date
8/17/2012
Contract Begin Date
8/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DAVID L. HILL, CHIEF EXECUTIVE OFFICER
(209) 966-3631 Ext: 272
Contract Pharmacy Representative
Patrick Crosby, Owner
(209) 962-5211
Signed By Date
7/16/2012
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