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DSH050133 RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout (Active)
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Main Details
Name
RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050133
Medicare Provider Number
050133
Additional Details
Current Program Status
Active
Registration Date
7/2/2018
Participating Start Date
7/2/2018
Participating Approval Date
7/2/2018
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Adventist Health + Rideout
Christopher Mathewson Champlin, President/CEO
(530) 751-4242
Primary Contact
Rideout Health
Israel Camacho, 340B Program Coordinator
(559) 723-2514
Addresses
Street Address
726 4TH STREET
MARYSVILLE, CA 95901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2006, terminated 4/1/2018. Reinstated 7/2/2018.
07/02/2018
02/24/2011 ADDED BILL TO ADDR & NPI#.
02/24/2011
April 2025
April 2025
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