340B Drug Pricing Program Database
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DSH050025BH UCSD MEDICAL CENTER (Active)
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Main Details
Name
UCSD MEDICAL CENTER
Subdivision Name
Senior Intensive Outpatient Psychiatry
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050025BH
Medicare Provider Number
050025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/6/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
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
410 Dickinson Street
San Diego, CA 92103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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