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BIOSCRIPINFUSIONSERVICESINC
DSH050292 Riverside University Health System
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Covered Entity Details
Entity Name
Riverside University Health System
Subdivision Name
formerly known as RIVERSIDE COUNTY REGIONAL MEDICAL CENTER aka Riverside General Hospital
Type
Disproportionate Share Hospital
340B ID
DSH050292
Entity Address
26520 Cactus Avenue
MORENO VALLEY, CA 92555
Medicare Provider Number
050292
Participating Start Date
12/1/1992
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
BIOSCRIPINFUSIONSERVICESINC
Pharmacy Address
320 S. FLOWER STREET
BURBANK, CA 91502
Pharmacy Comments
Contract Details
Approval Date
10/13/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Cruikshank, Chief Operating Officer
(951) 486-4458
Contract Pharmacy Representative
Gevork Azatyan, PIC
(818) 333-1700
Signed By Date
10/13/2015
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