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MEDICAL CENTER PHARMACY
DSH050077 SCRIPPS MERCY HOSPITAL
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Covered Entity Details
Entity Name
SCRIPPS MERCY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050077
Entity Address
4077 FIFTH AVENUE
SAN DIEGO, CA 92103
Medicare Provider Number
050077
Participating Start Date
1/1/2005
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
MEDICAL CENTER PHARMACY
855 THIRD AVENUE
SUITE 1102
CHULA VISTA, CA 91911-9210
Pharmacy Comments
Contract Details
Approval Date
10/10/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/27/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tom Gammiere, CEO
(619) 260-7101
Contract Pharmacy Representative
Community Medical Center Pharmacy
Michelle Darnelle, Operations / Business Development Manager
(619) 206-0117
Signed By Date
10/10/2013
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