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DSH050382 EMANATE HEALTH MEDICAL CENTER (Active)
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Main Details
Name
EMANATE HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050382
Medicare Provider Number
050382
Additional Details
Current Program Status
Active
Registration Date
4/10/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/28/2017
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Emanate Health
Gurjeet Kalkat, Chief Medical Officier
(626) 337-7331
Primary Contact
Emanate Health Medical Center-Inter-Community & Queen of the Valley Hospitals
Lori Jackson, Pharmacy 340B Program Coordinator
(626) 813-2953
Addresses
Street Address
210 WEST SAN BERNARDINO ROAD
COVINA, CA 91723
Billing Address
Emanate Health Medical Center - Inter-Community Hospital
PO Box 6108
Covina, CA 91722-5108
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/28/17 Participating 4/1/2017 until terminated effective 4/1/2017, reinstated effective 7/1/2017.
04/28/2017
2/13/17 Participated starting 4/1/2006, terminated 10/1/2015. Reinstated 4/1/2017.
02/13/2017
April 2025
April 2025
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