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WAL-MART PHARMACY 10-2032
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
WAL-MART PHARMACY 10-2032
Pharmacy Address
2001 NORTH ROSE AVENUE
OXNARD, CA 93036
Pharmacy Comments
Contract Details
Approval Date
1/20/2015
Contract Begin Date
4/1/2015
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
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/20/2015
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