Contract Pharmacy Details

MEDICAL PLAZA PHARMACY
DSH050159R VENTURA COUNTY MEDICAL CENTER

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

MEDICAL PLAZA PHARMACY

Pharmacy Address

SCRIPT COMPANY, INC. DBA
353 CENTRAL AVENUE
FILLMORE, CA 93015

Pharmacy Comments

Contract Details

Approval Date

7/16/2014

Contract Begin Date

10/1/2014

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

Roger's Pharmacy
Mukesh Rai, Owner
(805) 981-3366

Signed By Date

7/16/2014

340B Drug Pricing Program Database