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DSH050599FC UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Approved)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Operating Room - NEURO MONITORING SERVICES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599FC
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/10/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/8/2025
Last Recertification Date
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
4868 X 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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May 2025
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