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DSH050115H PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido) (Active)
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Main Details
Name
PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)
Subdivision Name
Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050115H
Medicare Provider Number
050115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/21/2015
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Palomar Health
Diane Lynette Hansen, President & CEO
(760) 740-6395
Primary Contact
Palomar Health
Dondreia Gelios, District Director Pharmacy Services
(442) 281-1358
Addresses
Street Address
2130 Citracado Parkway Suite 110A
San Escondido, CA 92029
Billing Address
Palomar Health
120 Craven Road
200
San Marcos, CA 92078
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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