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SCH050335-39 ADVENTIST HEALTH SONORA (Terminated)
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Main Details
Name
ADVENTIST HEALTH SONORA
Subdivision Name
Forest Road Pediatrics - Pediatrics
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH050335-39
Medicare Provider Number
050335
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/1/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Adventist Health Sonora
Greg McCulloch, President
(209) 536-5012
Primary Contact
Adventist Health Sonora
Ashley Pedroni, 340B Program Compliance Analyst
(209) 536-3704
Addresses
Street Address
193 South Fairview Lane
Suite L
Sonora, CA 95370
Billing Address
Sonora Community Hospital DBA Adventist Health Sonora
1000 Greenley Road
Sonora, CA 95370
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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