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DSH050342H PIONEERS MEMORIAL HOSPITAL (Active)
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Main Details
Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Pioneers Children's Health Center - Pioneers Children's Health Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050342H
Medicare Provider Number
050342
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/15/2019
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
565 Main Street
Brawley, CA 92227
Billing Address
Pioneers Memorial Healthcare District
207 W Legion Rd
Brawley, CA 92227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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