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DSH050231A POMONA VALLEY HOSPITAL MEDICAL CENTER (Active)
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Main Details
Name
POMONA VALLEY HOSPITAL MEDICAL CENTER
Subdivision Name
Pomona Valley Hospital Medical Center Cancer Care Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050231A
Medicare Provider Number
050231
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/25/2013
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Pomona Valley Hospital Medical Center
Darlene Scafiddi, Executive Vice President Chief Operating Officer
(909) 865-9879
Primary Contact
Pomona Valley Hospital Medical Center
Clifford Hiroshige, Director of Pharmacy
(909) 865-9656
Addresses
Street Address
1910 Royalty Drive
Pomona, CA 91767
Billing Address
Pomona Valley Hospital Medical Center
PO Box 741532
Los Angeles, CA 90074-1532
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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