340B Drug Pricing Program Database
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DSH050292J Riverside University Health System (Terminated)
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Main Details
Name
Riverside University Health System
Subdivision Name
RUHS - MEDICAL CENTER - RUH MSC FAMILY CARE / 90-170880 - FAMILY CARE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050292J
Medicare Provider Number
050292
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/22/2021
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
RUHS
Leah Patterson, Chief Nursing Officer
(951) 486-7532
Primary Contact
RUHS
Davalyn Tidwell, Pharmacy Director
(951) 486-4527
Addresses
Street Address
26600 CACTUS AVE STE 100
MORENO VALLEY, CA 92555-3927
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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