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THE VONS COMPANIES INC
DSH290007 UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
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Covered Entity Details
Entity Name
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH290007
Entity Address
1800 W Charleston Blvd.
LAS VEGAS, NV 89102
Medicare Provider Number
290007
Participating Start Date
7/1/1994
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
THE VONS COMPANIES INC
Pharmacy Address
VONS PHARMACY #1963
1155 EAST TWAIN AVENUE
LAS VEGAS, NV 89169
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/8/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Brannman, CEO
(702) 383-3862
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
1/16/2014
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