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DSH050367 NorthBay Healthcare Group (Active)
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Main Details
Name
NorthBay Healthcare Group
Subdivision Name
NORTH BAY MEDICAL CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050367
Medicare Provider Number
050367
Additional Details
Current Program Status
Active
Registration Date
7/1/2005
Participating Start Date
7/1/2005
Participating Approval Date
7/20/2005
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
NorthBay Health
Joseph D'Angina, Chief Financial Officer
(707) 646-3111
Primary Contact
NorthBay Health
Hy Ton, Director of Pharmacy
(707) 624-8151
Addresses
Street Address
1200 B GALE WILSON BLVD
FAIRFIELD, CA 94533
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/20/05 MOD ENT NAME (WAS NORTHBAY HEALTHCARE GROUP); 8/20/05 REMOVED MEDICAID # (HSP40367F)
04/25/2008
2/24/12 Entity name change from Northbay Hospital Group, documentation provdided
07/01/2005
May 2025
May 2025
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