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CALEXICO PHARMACY
DSH050342 PIONEERS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050342
Entity Address
207 WEST LEGION ROAD
BRAWLEY, CA 92227
Medicare Provider Number
050342
Participating Start Date
9/2/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CALEXICO PHARMACY
Pharmacy Address
CALEXICO PHARMACY
420 E. 2ND STREET
CALEXICO, CA 92231
Pharmacy Comments
Contract Details
Approval Date
4/7/2011
Contract Begin Date
4/7/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2019
Ownership change
Contacts
Covered Entity Signing Official
DANIEL SMITH, CFO
(760) 351-3590
Contract Pharmacy Representative
Calexico
MUKESH BHATT, PHARMACIST / OWNER
(760) 357-1297
Signed By Date
4/5/2011
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