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RALPHS GROCERY CO
DSH050376 LOS ANGELES COUNTY (LAC)
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Covered Entity Details
Entity Name
LOS ANGELES COUNTY (LAC)
Subdivision Name
HARBOR-UCLA MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050376
Entity Address
1000 WEST CARSON ST.
TORRANCE, CA 90502
Medicare Provider Number
050376
Participating Start Date
7/1/1997
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO
Pharmacy Address
DBA RALPHS #111
2201 W REDONDO BEACH BLVD
GARDENA, CA 90247
Pharmacy Comments
Contract Details
Approval Date
9/6/2012
Contract Begin Date
9/6/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/28/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Delvecchio Finley, Chief Executive Officer
(310) 222-2101
Contract Pharmacy Representative
Kenny Kimball, VP Merchandising
(310) 884-4581
Signed By Date
9/5/2012
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