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OWL SPECIALTY 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
OWL SPECIALTY PHARMACY
Pharmacy Address
1010 E. ARROW HWY
COVINA, CA 91724-1020
Pharmacy Comments
Contract Details
Approval Date
7/26/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROGER ARMSTRONG, CFO
(760) 351-3590
Contract Pharmacy Representative
Altscripts Specialty Pharmacy
Jamie Shaw, Director of Compliance
(414) 469-8333
Signed By Date
7/26/2017
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