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JCH LTC PHARMACY LLC
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050599
Entity Address
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Medicare Provider Number
050599
Participating Start Date
1/1/1999
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
JCH LTC PHARMACY LLC
Pharmacy Address
DBA PUCCI'S LTC PHARMACY
1428 33RD ST
SACRAMENTO, CA 95816
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheryl Ann Sadro, Chief Financial Officer
(916) 703-5009
Contract Pharmacy Representative
Puccis Pharmacy
Clint Hopkins, President
(916) 442-5891
Signed By Date
10/10/2023
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