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THE VONS COMPANIES INC
DSH050026 GROSSMONT HOSPITAL
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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
THE VONS COMPANIES INC
Pharmacy Address
VONS PHARMACY #2093
8011 UNIVERSITY AVE
LA MESA, CA 91942-5520
Pharmacy Comments
Contract Details
Approval Date
12/10/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KARI CORNICELLI, CFO
(619) 740-4465
Contract Pharmacy Representative
Safeway
Merle Jarvill, Director, Managed Care
(623) 869-4260
Signed By Date
10/12/2012
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