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DESERT MEDICAL 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
DESERT MEDICAL PHARMACY
Pharmacy Address
1600 S IMPERIAL AVE
SUITE # 12
EL CENTRO, CA 92243-4242
Pharmacy Comments
Contract Details
Approval Date
3/9/2011
Contract Begin Date
3/9/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/1/2011
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