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CHICO PHARMACY
DSH050039 ENLOE MEDICAL CENTER
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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
10/11/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2020
Business decision by covered entity and/or pharmacy
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
10/11/2016
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