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THE MEDICINE SHOPPE #387
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
THE MEDICINE SHOPPE #387
Pharmacy Address
2611 EAST THOMPSON BLVD
UNIT 103
VENTURA, CA 93003
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kathleen Kellerhouse, Chief of Hospital Operations
(805) 652-6052
Contract Pharmacy Representative
Independent
Bruce Sharp, Owner
(805) 648-2724
Signed By Date
10/16/2014
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