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FARMACIA DEL PUEBLO
DSH050045 EL CENTRO REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
EL CENTRO REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050045
Entity Address
1415 ROSS AVENUE
EL CENTRO, CA 92243
Medicare Provider Number
050045
Participating Start Date
10/1/2006
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
FARMACIA DEL PUEBLO
Pharmacy Address
1692 S 4TH ST
STE F
EL CENTRO, CA 92243
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALEX WELLS, CFO
(760) 370-3774
Contract Pharmacy Representative
Pharmacy Specialist Group Inc
Satish Gunda, Owner
(212) 234-2050
Signed By Date
7/12/2013
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