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DSH050057E KAWEAH DELTA HEALTH CARE DISTRICT (Terminated)
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Main Details
Name
KAWEAH DELTA HEALTH CARE DISTRICT
Subdivision Name
KAWEAH DELTA PORTERVILLE DIALYSIS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057E
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2008
Participating Start Date
7/1/2005
Participating Approval Date
4/11/2008
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Kaweah Delta Health Care District
GARY K. HERBST, Chief Executive Officer
(559) 624-2330
Primary Contact
Magdalena Ordon, Pharmacy Business Coordinator
(559) 624-5091
Addresses
Street Address
385 N PEARSON
PORTERVILLE, CA 93257
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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