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NOB HILL PHARMACY #605
CAH051337-00 HAZEL HAWKINS MEM. HOSPITAL
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Covered Entity Details
Entity Name
HAZEL HAWKINS MEM. HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051337-00
Entity Address
911 SUNSET DRIVE
HOLLISTER, CA 95023
Medicare Provider Number
051337
Participating Start Date
10/1/2021
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
NOB HILL PHARMACY #605
Pharmacy Address
1700 AIRLINE HIGHWAY
HOLLISTER, CA 95023
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARK ROBINSON, CFO
(831) 636-2604
Contract Pharmacy Representative
Raley's
Alisha Reynoso, Pharmacy Operations
(916) 376-6687
Signed By Date
10/15/2021
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