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DSH050599DV UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
HBC Wound Care Ellison - HBC Wound Care Clinic Ellison
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599DV
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/30/2024
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
UC Davis Health
Jennifer L Doll, Chief Financial Officer
(916) 708-2708
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
4860 Y Street
Sacramento, CA 95817
Billing Address
UC Davis Medical Center Accounts Payable
PO Box 168016
Sacramento, CA 95816
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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