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MEDICAL CENTER PHARMACY
DSH050100 SHARP MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHARP MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050100
Entity Address
7901 FROST STREET
SAN DIEGO, CA 92123
Medicare Provider Number
050100
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
MEDICAL CENTER PHARMACY
Pharmacy Address
7910 FROST STREET
SUITE 130
SAN DIEGO, CA 92123
Pharmacy Comments
Contract Details
Approval Date
7/9/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/2/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TIM SMITH, CEO
(858) 939-4082
Contract Pharmacy Representative
George Awad, Pharmacy Director
(619) 997-4702
Signed By Date
7/9/2015
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