340B Drug Pricing Program Database
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DSH050025S UCSD MEDICAL CENTER (Active)
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Main Details
Name
UCSD MEDICAL CENTER
Subdivision Name
UCSD Medical Offices South - Owen Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050025S
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
4168 Front Street
San Diego, CA 92103
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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