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DSH050093 SAINT AGNES MEDICAL CENTER (Active)
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Main Details
Name
SAINT AGNES MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050093
Medicare Provider Number
050093
Additional Details
Current Program Status
Active
Registration Date
2/29/2008
Participating Start Date
1/1/2014
Participating Approval Date
3/1/2008
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Saint Alphonsus Health System
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Primary Contact
Trinity Health
Carisa Ann McGehee, 340B Analyst
(208) 367-2087
Addresses
Street Address
1303 E HERNDON AVE
FRESNO, CA 93720
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/13/13 enrolled 4/1/08 thru 8/12/13, not enrolled 8/13/13 thru 12/31/13 for failure to meet GPO prohibition requirements, re-instated based on on-line registration received in Oct. 2013
12/13/2013
site terminated 8/8/13 for failure to meet GPO prohibition requirements
08/13/2013
April 2025
April 2025
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