Contract Pharmacy Details

AIDS HEALTHCARE FOUNDATION
DSH050025 UCSD MEDICAL CENTER

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

AIDS HEALTHCARE FOUNDATION

Pharmacy Address

AHF PHARMACY
3580 5TH AVE STE 200
SAN DIEGO, CA 92103

Pharmacy Comments

Contract Details

Approval Date

7/17/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lori Donaldson, CFO
(619) 543-6613

Contract Pharmacy Representative

AIDS HEALTHCARE FOUNDATION
Peter Reis, Senior Vice President
(323) 860-5208

Signed By Date

7/17/2013

340B Drug Pricing Program Database