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DSH050599DZ UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Bone Marrow Transplant - Cancer Center Clinics -Benign Hematology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599DZ
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/8/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
UC Davis Health
Noel Sousa, Interim CFO
(916) 496-7593
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
3301 C Street
Sacramento, CA 95816
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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