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RALPHS GROCERY CO
DSH050222 SHARP CHULA VISTA MEDICAL CENTER
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Covered Entity Details
Entity Name
SHARP CHULA VISTA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050222
Entity Address
751 MEDICAL CENTER COURT
CHULA VISTA, CA 91911
Medicare Provider Number
050222
Participating Start Date
7/1/2004
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO
Pharmacy Address
DBA RALPHS #235
659 E. PALOMAR STREET
CHULA VISTA, CA 91911
Pharmacy Comments
Contract Details
Approval Date
4/2/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/29/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICK KING, CFO
(619) 502-3664
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
4/2/2013
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