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UCSD MOORES CANCER CENTER
DSH050348 UCI MEDICAL CENTER
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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
UCSD MOORES CANCER CENTER
Pharmacy Address
3855 HEALTH SCIENCES DR RM 1036
LA JOLLA, CA 92093-0845
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chad Thurman Lefteris, CEO
(714) 714-1423
Contract Pharmacy Representative
UCSD Health
Tracey Spangenberg, Assoc Chief Pharmacy officer
(760) 707-9939
Signed By Date
4/14/2025
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