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CALEXICO RX INC
DSH050342 PIONEERS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050342
Entity Address
207 WEST LEGION ROAD
BRAWLEY, CA 92227
Medicare Provider Number
050342
Participating Start Date
9/2/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CALEXICO RX INC
Pharmacy Address
DBA: CALEXICO PHARMACY
420 E. 2ND STREET
CALEXICO, CA 92231
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/8/2019
Ownership change
Contacts
Covered Entity Signing Official
ROGER ARMSTRONG, CFO
(760) 351-3590
Contract Pharmacy Representative
Calexico RX Inc.
Mukesh B. Bhatt, Owner
(760) 357-1200
Signed By Date
4/15/2019
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