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ALL-MED DRUGS
DSH050159R VENTURA COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
VENTURA COUNTY MEDICAL CENTER
Subdivision Name
Orthopedic Clinic
Type
Disproportionate Share Hospital
340B ID
DSH050159R
Entity Address
300 HILLMONT AVE
Ventura, CA 93003
Medicare Provider Number
050159
Outpatient Facility Provider Number
Participating Start Date
1/1/1998
Last Recertification Date
8/31/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
ALL-MED DRUGS
Pharmacy Address
442 N. MOORPARK RD.
THOUSAND OAKS, CA 91360
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathleen Kellerhouse, Chief of Hospital Operations
(805) 652-6052
Contract Pharmacy Representative
Mukesh Rai, Owner
(805) 495-2110
Signed By Date
7/12/2013
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