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DSH050516 MERCY SAN JUAN MEDICAL CENTER (Active)
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Main Details
Name
MERCY SAN JUAN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050516
Medicare Provider Number
050516
Additional Details
Current Program Status
Active
Registration Date
2/22/2006
Participating Start Date
4/1/2005
Participating Approval Date
2/22/2006
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Mercy San Juan Medical Center
Randall Reyes, CFO
(916) 537-5153
Primary Contact
CommonSpirit Health
Ryan Pearcy, 340B Region Manager
(859) 229-5654
Addresses
Street Address
6501 COYLE AVENUE
CARMICHAEL, CA 95608
Billing Address
Dignity Health AP SAC
3400 Data Drive
Rancho Cordova, CA 95670
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/31/06 - REPLACES DSH95608 7/10/06 - NEW CONTACT
07/10/2006
3/31/06 - REPLACES DSH95608 7/10/06 - NEW CONTACT
07/10/2006
April 2025
April 2025
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