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DSH050305B ALTA BATES SUMMIT MED - HERRICK (ABSM-H) (Terminated)
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Main Details
Name
ALTA BATES SUMMIT MED - HERRICK (ABSM-H)
Subdivision Name
COMPREHENSIVE CANCER CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050305B
Medicare Provider Number
050305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/1/2006
Participating Start Date
7/1/2006
Participating Approval Date
6/1/2006
Last Recertification Date
8/26/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Sutter Health
Patti Pilgrim, CFO
(510) 869-8620
Primary Contact
Sutter Health
Mary Reiter, Asst. Director Pharmacy-Outpatient
(510) 869-8489
Addresses
Street Address
2001 DWIGHT WAY
room 1125
BERKELEY, CA 94704
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/12/12 add medicaid number
03/12/2012
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