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DINUBA PHARMACY
DSH050121 Adventist Medical Center
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Covered Entity Details
Entity Name
Adventist Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050121
Entity Address
115 mall drive
HANFORD, CA 93230
Medicare Provider Number
050121
Participating Start Date
1/1/2008
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
DINUBA PHARMACY
Pharmacy Address
DINUBA PHARMACY
172 N L ST.
DINUBA, CA 93618
Pharmacy Comments
Contract Details
Approval Date
4/4/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Michael Haydock, CFO
(559) 537-0050
Contract Pharmacy Representative
Dinuba Pharmacy
Emad Morcos, President
(559) 725-4525
Signed By Date
4/4/2019
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