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DSH050369 CITRUS VALLEY MEDICAL CENTER - QV CAMPUS (Terminated)
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Main Details
Name
CITRUS VALLEY MEDICAL CENTER - QV CAMPUS
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050369
Medicare Provider Number
050369
Additional Details
Current Program Status
Terminated
Registration Date
2/15/2006
Participating Start Date
4/1/2006
Participating Approval Date
2/15/2006
Last Recertification Date
9/9/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Edward Jai, Vice President, Pharmacy and Population Health
(626) 260-1411
Primary Contact
Sheri Hustana, Director of Pharmacy
(626) 813-2812
Addresses
Street Address
1115 S SUNSET AVE
WEST COVINA, CA 91790
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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