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MEDICINE SHOPPE
CAH051334-00 OJAI VALLEY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
OJAI VALLEY COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051334-00
Entity Address
1306 MARICOPA HIGHWAY
OJAI, CA 93023
Medicare Provider Number
051334
Participating Start Date
1/1/2017
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MEDICINE SHOPPE
Pharmacy Address
960 E OJAI AVENUE
OJAI, CA 93023
Pharmacy Comments
Contract Details
Approval Date
1/4/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2019
Ownership change
Contacts
Covered Entity Signing Official
DAVID BURRIS GLYER, cfo
(805) 652-5003
Contract Pharmacy Representative
Amani Hishmeh, President
(805) 646-0106
Signed By Date
1/4/2017
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