340B Drug Pricing Program Database
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DSH050516A MERCY SAN JUAN MEDICAL CENTER (Terminated)
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Main Details
Name
MERCY SAN JUAN MEDICAL CENTER
Subdivision Name
MERCY SAN JUAN SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050516A
Medicare Provider Number
050516
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/22/2006
Participating Start Date
4/1/2006
Participating Approval Date
2/22/2006
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Mercy San Juan Medical Center
Randall Reyes, CFO
(916) 537-5153
Primary Contact
Dignity Health
Jim Walsh, Director of Pharmacy
(916) 537-5369
Addresses
Street Address
6660 COYLE AVENUE
CARMICHAEL, CA 95608
Billing Address
Dignity Health Accounts Payable
3400 Data Drive
Rancho Cordova, CA 95670
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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