Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
DSH050454 UCSF-MEDICAL CENTER

Covered Entity Details

Entity Name

UCSF-MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050454

Entity Address

505 PARNASSUS AVE.
SAN FRANCISCO, CA 94143

Medicare Provider Number

050454

Participating Start Date

7/1/1993

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 17674
1830 OCEAN AVE
SAN FRANCISCO, CA 94112

Pharmacy Comments

Contract Details

Approval Date

1/16/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/26/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Sheila Antrum, SVP-AdultSvcs/President-MedCtr
(415) 353-2717

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/16/2018

340B Drug Pricing Program Database