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CRYSTAL MEDICAL CENTER PHARMACY
DSH050030 OROVILLE HOSPITAL
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Covered Entity Details
Entity Name
OROVILLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050030
Entity Address
2767 OLIVE HIGHWAY
OROVILLE, CA 95966
Medicare Provider Number
050030
Participating Start Date
7/1/2006
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CRYSTAL MEDICAL CENTER PHARMACY
Pharmacy Address
ODEDRA ENTERPRISES, INC. DBA
2809 OLIVE HWY STE 160
OROVILLE, CA 95966-6133
Pharmacy Comments
Contract Details
Approval Date
4/1/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ASHOK P. KHANCHANDANI, EXECUTIVE VICE PRESIDENT/CFO
(530) 532-8509
Contract Pharmacy Representative
Crystal Medical Center Pharmacy
Harish Odedra, CEO
(530) 533-1545
Signed By Date
4/1/2016
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