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RALPHS PHARMACY #222
DSH050040 OLIVE VIEW MEDICAL CENTER
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Covered Entity Details
Entity Name
OLIVE VIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050040
Entity Address
14445 OLIVE VIEW DR.
SYLMAR, CA 91342
Medicare Provider Number
050040
Participating Start Date
1/1/1998
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
RALPHS PHARMACY #222
Pharmacy Address
14049 VENTURA BLVD
SHERMAN OAKS, CA 91403
Pharmacy Comments
Contract Details
Approval Date
8/29/2012
Contract Begin Date
8/29/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/26/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Carolyn Rhee, CEO
(818) 364-3001
Contract Pharmacy Representative
Kenny Kimball, VP of Marketing
(310) 884-9000
Signed By Date
7/27/2012
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