Contract Pharmacy Details

THE VONS COMPANIES INC
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

THE VONS COMPANIES INC

Pharmacy Address

VONS PHARMACY #3044
1201 AVOCADO AVENUE
EL CAJON, CA 92020

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
Thuy Le, 340B Program Manager
(925) 467-2825

Signed By Date

10/12/2012

340B Drug Pricing Program Database