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RIVERSIDE COUNTY RUBIDOUX PHARMACY
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
RIVERSIDE COUNTY RUBIDOUX PHARMACY
Pharmacy Address
5256 MISSION BLVD
JURUPA VALLEY, CA 92509-4624
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/8/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Cruikshank, Chief Executive Officer
(951) 486-4458
Contract Pharmacy Representative
Donna Apostol, Managing Pharmacist
(877) 748-2679
Signed By Date
4/14/2017
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