Contract Pharmacy Details

UCI HEALTH-COSTA MESA HOME INFUSION PHAR
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

UCI HEALTH-COSTA MESA HOME INFUSION PHAR

Pharmacy Address

PHARMACY
1640 NEWPORT BLVD STE 400
COSTA MESA, CA 92627

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

5/18/2017
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

UCI Health
Melanie Joe, Chief Pharmacy Officer
(714) 456-5514

Signed By Date

7/20/2015

340B Drug Pricing Program Database