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CRESCENT HEALTHCARE, 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
CRESCENT HEALTHCARE, INC.
Pharmacy Address
11980 TELEGRAPH RD.
SUITE 100
SANTA FE SPRINGS, CA 90670-6089
Pharmacy Comments
Contract Details
Approval Date
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055
Contract Pharmacy Representative
Option Care
Shanna Brown, Business Analyst
(602) 453-2013
Signed By Date
7/7/2017
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