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RALPHS GROCERY CO.
DSH050231 POMONA VALLEY HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
POMONA VALLEY HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050231
Entity Address
1798 NORTH GAREY AVENUE
POMONA, CA 91767
Medicare Provider Number
050231
Participating Start Date
1/1/2007
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO.
Pharmacy Address
DBA: RALPHS #113
16225 SIERRA LAKES PARKWAY
FONTANA, CA 92336-1245
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/14/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICHARD YOCHUM, CEO
(909) 865-9500 Ext: 9975
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/14/2016
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