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ORANGE GROVE PHARMACY
DSH050231 POMONA VALLEY HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
POMONA VALLEY HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050231
Entity Address
1798 NORTH GAREY AVENUE
POMONA, CA 91767
Medicare Provider Number
050231
Participating Start Date
1/1/2007
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ORANGE GROVE PHARMACY
Pharmacy Address
1770 N ORANGE GROVE AVE STE 100
POMONA, CA 91767-3027
Pharmacy Comments
Contract Details
Approval Date
12/10/2007
Contract Begin Date
12/10/2007
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/16/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/10/2007
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