Contract Pharmacy Details

GARDEN GROVE COMMUNITY PHARMACY
DSH050348 UCI MEDICAL CENTER

Covered Entity Details

Entity Name

UCI MEDICAL CENTER

Subdivision Name

UNIVERSITY OF CALIFORNIA, IRVINE

Type

Disproportionate Share Hospital

340B ID

DSH050348

Entity Address

101 THE CITY DR. S RT32
ORANGE, CA 92868

Medicare Provider Number

050348

Participating Start Date

1/1/1998

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

GARDEN GROVE COMMUNITY PHARMACY

Pharmacy Address

12665 GARDEN GROVE BLVD STE 108
GARDEN GROVE, CA 92843-1915

Pharmacy Comments

Contract Details

Approval Date

7/20/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Howard Federoff, CEO & Vice Chancellor, Health Affairs
(949) 824-5926

Contract Pharmacy Representative

Advantage Health Care Services
Shekha Patel, Pharmacist In Charge
(714) 530-1130

Signed By Date

7/20/2015

340B Drug Pricing Program Database