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DSH050342C PIONEERS MEMORIAL HOSPITAL (Active)
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Main Details
Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Oncology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050342C
Medicare Provider Number
050342
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/5/2014
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Pioneers Memorial Hospital
Carly Loper, Chief Financial Officer
(760) 351-3594
Primary Contact
Pioneers Memorial Hospital
John Paul Teague, Director of Pharmacy
(760) 351-3278
Addresses
Street Address
205 W Legion Road
Brawley, CA 92227
Billing Address
Pioneers Memorial Hospital
207 W Legion Road
Brawley, CA 92227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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