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INJECTABLE THERAPY SERVICES, INC.
DSH050301 ADVENTIST HEALTH UKIAH VALLEY
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Covered Entity Details
Entity Name
ADVENTIST HEALTH UKIAH VALLEY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050301
Entity Address
275 HOSPITAL DRIVE
UKIAH, CA 95482
Medicare Provider Number
050301
Participating Start Date
1/1/2007
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
INJECTABLE THERAPY SERVICES, INC.
Pharmacy Address
BIOMATRIX SPECIALTY PHARMACY CA
7959 DEERING AVE
CANOGA PARK, CA 91304-5009
Pharmacy Comments
Contract Details
Approval Date
4/8/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Judson Howe, Network President
(707) 467-5352
Contract Pharmacy Representative
Med Center Specialty Pharmacy
Nicholas Karalis, President
(610) 545-6040 Ext: 206
Signed By Date
4/8/2020
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