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DSH050057AR Kaweah Delta Health Care District DBA Kaweah Health (Terminated)
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Main Details
Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
KAWEAH DELTA HEALTH CARE DISTRICT - Kaweah Health Medical Clinic - Plaza
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057AR
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Termination Date
Termination Reason
4/1/2025
Never implemented the 340B Program
Contacts
Authorizing Official
Kaweah Delta Health Care District DBA Kaweah Health
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Primary Contact
Kaweah Delta Health Care District DBA Kaweah Health
Allison E Gonzalez, Pharmacy Business Manager
(559) 624-5328
Addresses
Street Address
1329 N PLAZA DR
VISALIA, CA 93291-8838
Billing Address
Kaweah Delta Health Care District dba Kaweah Health - Visalia, CA
400 W. Mineral King Ave.
Visalia, CA 93291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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