Contract Pharmacy Details

CORAM HEALTHCARE CORP OF SOUTHERN CALIFO
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

CORAM HEALTHCARE CORP OF SOUTHERN CALIFO

Pharmacy Address

DBA CORAM CVS/SPECIALTY INFUSION SERVICE
2710 MEDIA CENTER DRIVE, BLDG. #6,
SUITE 150
LOS ANGELES, CA 90065

Pharmacy Comments

Contract Details

Approval Date

4/13/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2020
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

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/13/2017

340B Drug Pricing Program Database