Contract Pharmacy Details

CHICO PHARMACY
DSH050039 ENLOE MEDICAL CENTER

Covered Entity Details

Entity Name

ENLOE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH050039

Entity Address

1531 ESPLANADE
CHICO, CA 95926

Medicare Provider Number

050039

Participating Start Date

1/1/2017

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

CHICO PHARMACY

Pharmacy Address

251 COHASSET RD
STE 100
CHICO, CA 95926-2235

Pharmacy Comments

Contract Details

Approval Date

1/15/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Myron Machula, VP/CFO
(530) 332-7357

Contract Pharmacy Representative

SHAUN SIMS, DIRECTOR OF PHARMACY AFFAIRS
(530) 343-4440

Signed By Date

1/15/2015