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DSH050342K PIONEERS MEMORIAL HOSPITAL (Active)
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Main Details
Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Pioneers Memorial Healthcare District-Womens Health - Womens Health at Pioneers
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050342K
Medicare Provider Number
050342
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/12/2023
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 Suite 201
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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