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FOX DRUG STORE
DSH050192 Reedley Community Hospital dba Adventist Health Reedley
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Covered Entity Details
Entity Name
Reedley Community Hospital dba Adventist Health Reedley
Subdivision Name
Reedley Community Hospital
Type
Disproportionate Share Hospital
340B ID
DSH050192
Entity Address
372 W. Cypress Ave
Reedley, CA 93654
Medicare Provider Number
050192
Participating Start Date
10/1/2013
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
FOX DRUG STORE
Pharmacy Address
13660 E MANNING AVE STE 102
PARLIER, CA 93648-9743
Pharmacy Comments
Contract Details
Approval Date
7/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David L. Larsen, SR VP CFO
(559) 537-0050
Contract Pharmacy Representative
Sunnyside Pharmacy
Lunny Jung, CEO
(213) 590-2375
Signed By Date
7/11/2013
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