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HIGH DESERT REGIONAL HEALTH CENTER PHARM
DSH050040 OLIVE VIEW MEDICAL CENTER
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Covered Entity Details
Entity Name
OLIVE VIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050040
Entity Address
14445 OLIVE VIEW DR.
SYLMAR, CA 91342
Medicare Provider Number
050040
Participating Start Date
1/1/1998
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
HIGH DESERT REGIONAL HEALTH CENTER PHARM
Pharmacy Address
OUTPATIENT
335 E AVENUE I
RM 1A14
LANCASTER, CA 93535
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/18/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JUDITH MAASS, CEO
(747) 210-3001
Contract Pharmacy Representative
High Desert Regional Health Center
Romina Panoussi, Chief of Pharmacy
(661) 471-4107
Signed By Date
7/10/2018
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