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MED CARE PHARMACY
DSH050128 TRI-CITY MEDICAL CENTER
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Covered Entity Details
Entity Name
TRI-CITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050128
Entity Address
4002 VISTA WAY
OCEANSIDE, CA 92056-4506
Medicare Provider Number
050128
Participating Start Date
1/1/2019
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MED CARE PHARMACY
Pharmacy Address
MED MATRIX PHARMACY , INC
161 THUNDER DR STE 100
VISTA, CA 92083
Pharmacy Comments
Contract Details
Approval Date
4/20/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ray Rivas, Chief Financial Officer
(760) 940-3352
Contract Pharmacy Representative
Med Care Pharmacy
John Ahn, President
(760) 758-7650
Signed By Date
4/20/2023
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