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DSH050025BG UCSD MEDICAL CENTER (Active)
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Main Details
Name
UCSD MEDICAL CENTER
Subdivision Name
Maternal-Fetal Care and Genetics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050025BG
Medicare Provider Number
050025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
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
4910 Directors Place
Suite 200
San Diego, CA 92121
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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