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RALPHS GROCERY CO
DSH050126 Valley Presbyterian Hospital
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Covered Entity Details
Entity Name
Valley Presbyterian Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050126
Entity Address
15107 Vanowen Street
Van Nuys, CA 91405
Medicare Provider Number
050126
Participating Start Date
1/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO
Pharmacy Address
DBA RALPHS #219
16325 VENTURA BLVD
ENCINO, CA 91436
Pharmacy Comments
Contract Details
Approval Date
7/2/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LORI CARDLE, SVP Finance, CFO
(818) 902-5235
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/2/2020
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