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RIVER CITY PHARMACY, INC.
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050599
Entity Address
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Medicare Provider Number
050599
Participating Start Date
1/1/1999
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
RIVER CITY PHARMACY, INC.
Pharmacy Address
OPTION CARE
3301 C ST., STE 450
SACRAMENTO, CA 95816-3393
Pharmacy Comments
Contract Details
Approval Date
4/11/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055
Contract Pharmacy Representative
Option Care
Jenny Money, Senior Manager, Health Systems Programs
(773) 202-6786
Signed By Date
4/11/2016
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