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DSH050025AE UCSD MEDICAL CENTER (Active)
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Main Details
Name
UCSD MEDICAL CENTER
Subdivision Name
Moores Cancer Center Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050025AE
Medicare Provider Number
050025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
6/6/2012
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
3855 Health Sciences Drive
La Jolla, CA 92037
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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