Contract Pharmacy Details

CRESCENT HEALTHCARE INC
DSH050599 UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050599

Entity Address

2315 STOCKTON BLVD
SACRAMENTO, CA 95817

Medicare Provider Number

050599

Participating Start Date

1/1/1999

Last Recertification Date

8/22/2024

Pharmacy Details

Pharmacy Name

CRESCENT HEALTHCARE INC

Pharmacy Address

11980 TELEGRAPH RD
SUITE 102
SANTA FE SPRINGS, CA 90670-6089

Pharmacy Comments

Contract Details

Approval Date

1/11/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/10/2019
Ownership change

Contacts

Covered Entity Signing Official

TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055

Contract Pharmacy Representative

Option Care
Derek Bilyk, Program Manager, Health Systems
(224) 813-1283

Signed By Date

1/11/2018

340B Drug Pricing Program Database