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DSH050133A RIDEOUT MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
RIDEOUT MEMORIAL HOSPITAL
Subdivision Name
FREMONT MEDICAL CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050133A
Medicare Provider Number
050133
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/17/2006
Participating Start Date
7/1/2006
Participating Approval Date
5/18/2006
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
Rideout Memorial Hospital
Ed Gonzalez, CFO
(530) 751-4010
Primary Contact
JERRY F. GONZALES, DIRECTOR OF PHARMACY
(530) 749-4417 Ext: 4401
Addresses
Street Address
970 PLUMAS STREET
YUBA CITY, CA 95991
Billing Address
PO BOX 2128
MARYSVILLE, CA 95901
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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02/24/2011 ADDED BILL TO ADDR.;ADDED NPI#
02/24/2011
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