Contract Pharmacy Details

SHARP REES STEALY PHARMACY #6
DSH050026 GROSSMONT HOSPITAL

Covered Entity Details

Entity Name

GROSSMONT HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050026

Entity Address

5555 GROSSMONT CENTER DRIVE
LA MESA, CA 91942

Medicare Provider Number

050026

Participating Start Date

7/1/2004

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

SHARP REES STEALY PHARMACY #6

Pharmacy Address

2929 HEALTH CENTER DR
SAN DIEGO, CA 92123-2762

Pharmacy Comments

Contract Details

Approval Date

10/31/2012

Contract Begin Date

10/31/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/31/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

KARI CORNICELLI, CFO
(619) 740-4465

Contract Pharmacy Representative

Sharp Rees-Stealy
Josh Schmidt, Chief Financial Officer
(858) 616-8009

Signed By Date

9/28/2012

340B Drug Pricing Program Database