340B Drug Pricing Program Database
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DSH050025K UCSD MEDICAL CENTER (Active)
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Main Details
Name
UCSD MEDICAL CENTER
Subdivision Name
Shiley Eye Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050025K
Medicare Provider Number
050025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/24/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/25/2012
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
UCSD Medical Center
Lori Donaldson, CFO
(619) 543-6613
Primary Contact
UCSD Medical Center
Katrina Tolentino, 340B Program Coordinator
(619) 543-3104
Addresses
Street Address
9415 Campus Pt. Drive
3rd floor
La Jolla, CA 92093
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/10/2014 - Multiple terminations/reinstatements recorded in error; site remained continuously eligible from participation start date.
04/14/2014
03/25/2014: Termination recorded in error; site remained continuously eligible from participation start date.
03/31/2014
April 2025
April 2025
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