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DSH050122 DAMERON HOSPITAL ASSOCIATION (Active)
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Main Details
Name
DAMERON HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050122
Medicare Provider Number
050122
Additional Details
Current Program Status
Active
Registration Date
7/24/2006
Participating Start Date
10/1/2006
Participating Approval Date
7/26/2006
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Dameron Hospital
Timothy Karagounis, Operations Executive
(209) 461-7596 Ext: 2092007800
Primary Contact
Dameron Hospital Associate
John Michael Sandoval, Pharmacy Manager
(209) 461-3129
Addresses
Street Address
525 WEST ACACIA STREET
STOCKTON, CA 95203
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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