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DSH050301 ADVENTIST HEALTH UKIAH VALLEY (Active)
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Main Details
Name
ADVENTIST HEALTH UKIAH VALLEY
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050301
Medicare Provider Number
050301
Additional Details
Current Program Status
Active
Registration Date
12/1/2006
Participating Start Date
1/1/2007
Participating Approval Date
12/1/2006
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Adventist Health North Coast Network
Jeff Mock, Finance Officer, North Coast Network
(916) 406-1417
Primary Contact
Adventist Health Ukiah Valley
Tracy Dolmage, Pharmacy Analyst
(707) 463-7633
Addresses
Street Address
275 HOSPITAL DRIVE
UKIAH, CA 95482
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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ADJ % > 11.75
05/16/2007
April 2025
April 2025
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