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WAL-MART PHARMACY 10-2032
DSH050159AB VENTURA COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
VENTURA COUNTY MEDICAL CENTER
Subdivision Name
Pediatric Hematology-Oncology Clinic
Type
Disproportionate Share Hospital
340B ID
DSH050159AB
Entity Address
300 HILLMONT AVE, BLDG #340
#301
Ventura, CA 93003
Medicare Provider Number
050159
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2032
Pharmacy Address
2001 NORTH ROSE AVENUE
OXNARD, CA 93036
Pharmacy Comments
Contract Details
Approval Date
1/20/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathleen Kellerhouse, Chief of Hospital Operations
(805) 652-6052
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/20/2015
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