Contract Pharmacy Details

OCEANSIDE PHARMACY
DSH050128 TRI-CITY MEDICAL CENTER

Covered Entity Details

Entity Name

TRI-CITY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050128

Entity Address

4002 VISTA WAY
OCEANSIDE, CA 92056-4506

Medicare Provider Number

050128

Participating Start Date

1/1/2019

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

OCEANSIDE PHARMACY

Pharmacy Address

3601 VISTA WAY STE 103
OCEANSIDE, CA 92056-4559

Pharmacy Comments

Contract Details

Approval Date

4/11/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Ray Rivas, Chief Financial Officer
(760) 940-3352

Contract Pharmacy Representative

Tarun Wadhwa, Owner
(760) 231-5800

Signed By Date

4/11/2017