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DSH050342E PIONEERS MEMORIAL HOSPITAL (Active)
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Main Details
Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Center for Digestive and Liver Disease-Gastro Srvcs
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050342E
Medicare Provider Number
050342
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/26/2016
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
751 W Legion Road Sute 303
Brawley, CA 92227
Billing Address
Pioneers Memorial Healthcare District
207 W Legion Road
Brawley, CA 92227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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