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THE VONS COMPANIES INC
DSH050025 UCSD MEDICAL CENTER
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Covered Entity Details
Entity Name
UCSD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050025
Entity Address
200 WEST ARBOR DRIVE
SAN DIEGO, CA 92103
Medicare Provider Number
050025
Participating Start Date
12/1/1992
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
THE VONS COMPANIES INC
Pharmacy Address
PAVILIONS PHARMACY #2323
7544 GIRARD AVENUE
LA JOLLA, CA 92037
Pharmacy Comments
Contract Details
Approval Date
12/31/2012
Contract Begin Date
12/31/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lori Donaldson, CFO
(619) 543-6613
Contract Pharmacy Representative
Merle Jarvill, Director
(623) 869-4260
Signed By Date
10/12/2012
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