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PREMIER INFUSION AND HEALTHCARE SERVICES
CAN050146-00 CITY OF HOPE NATIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CITY OF HOPE NATIONAL MEDICAL CENTER
Subdivision Name
Type
Free Standing Cancer Hospital
340B ID
CAN050146-00
Entity Address
1500 E. DUARTE ROAD
DUARTE, CA 91010
Medicare Provider Number
050146
Participating Start Date
9/1/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PREMIER INFUSION AND HEALTHCARE SERVICES
Pharmacy Address
19500 NORMANDIE AVE
TORRANCE, CA 90502
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
Wafa Samara, CPO
(626) 218-4936
Contract Pharmacy Representative
Premier Infusion Care
Sina M. Refua, Director of Pharmacy/CFO
(866) 365-2525 Ext: 240
Signed By Date
10/15/2021
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