340B Drug Pricing Program Database
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DSH050382E EMANATE HEALTH MEDICAL CENTER (Active)
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Main Details
Name
EMANATE HEALTH MEDICAL CENTER
Subdivision Name
QVH - CT SCANNER - CT SCANNER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050382E
Medicare Provider Number
050382
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/16/2019
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
1115 S Sunset Ave.
West Covina, CA 91790
Billing Address
Emanate Health Medical Center – Queen of the Valley Hospital
PO Box 6108
Covina, CA 91722-5108
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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