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DSH050115E PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido) (Terminated)
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Main Details
Name
PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)
Subdivision Name
PHDC Operating Room/ Surgical Platform
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050115E
Medicare Provider Number
050115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/9/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/13/2013
Last Recertification Date
9/5/2016
Termination Date
Termination Reason
10/1/2016
Other
Contacts
Authorizing Official
Palomar Health
Carlos A. Bohorquez, Chief FInancial Officer
(760) 740-6385
Primary Contact
Palomar Health
Jeremy Lee, District Director Pharmacy Services
(760) 739-3935
Addresses
Street Address
555 E. Valley Parkway
Escondido, CA 92025
Billing Address
Palomar Health
800 W. Valley Parkway, Suite #201
Escondido, CA 92025
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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