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SHARP REES STEALY PHARMACY #2
DSH050100B SHARP MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHARP MEMORIAL HOSPITAL
Subdivision Name
Sharp Mary Birch Hospital for Women and Newborns
Type
Disproportionate Share Hospital
340B ID
DSH050100B
Entity Address
3003 Health Center Drive
San Diego, CA 92123
Medicare Provider Number
050100
Outpatient Facility Provider Number
Participating Start Date
7/1/2012
Last Recertification Date
8/18/2015
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
SHARP REES STEALY PHARMACY #2
Pharmacy Address
525 THIRD AVE
SUITE A
CHULA VISTA, CA 91910-5696
Pharmacy Comments
Contract Details
Approval Date
10/31/2012
Contract Begin Date
10/31/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
Kevin Thompson, Chief Financial Officer
(858) 939-3884
Contract Pharmacy Representative
Sharp Rees-Stealy
Josh Schmidt, Chief Financial Officer
(858) 616-8009
Signed By Date
9/28/2012
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