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SEENA PHARMACY
DSH050159U Ventura County Medical Center
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Covered Entity Details
Entity Name
Ventura County Medical Center
Subdivision Name
Ventura County Mental Health
Type
Disproportionate Share Hospital
340B ID
DSH050159U
Entity Address
200 Hillmont Ave.
Ventura, CA 93003
Medicare Provider Number
050159
Outpatient Facility Provider Number
Participating Start Date
4/1/2005
Last Recertification Date
9/5/2016
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
SEENA PHARMACY
Pharmacy Address
BASSO PHARMACY, INC. DBA
3901 LAS POSAS RD STE 101
CAMARILLO, CA 93010-1505
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
10/1/2016
Contacts
Covered Entity Signing Official
Kathleen Kellerhouse, Chief of Hospital Operations
(805) 652-6052
Contract Pharmacy Representative
Independent
Jasmine Razeghi, Owner
(805) 419-2686
Signed By Date
10/16/2014
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