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THE VONS COMPANIES INC
DSH050394 CMH OF SAN BUENAVENTURA
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Covered Entity Details
Entity Name
CMH OF SAN BUENAVENTURA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050394
Entity Address
147 N. BRENT STREET
VENTURA, CA 93003
Medicare Provider Number
050394
Participating Start Date
10/1/2019
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
THE VONS COMPANIES INC
Pharmacy Address
VONS PHARMACY #2431
2433 HARBOR BLVD
VENTURA, CA 93001
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DAVID BURRIS GLYER, cfo
(805) 652-5003
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
10/15/2019
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