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DSH050057F Kaweah Delta Health Care District DBA Kaweah Health (Terminated)
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Main Details
Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
KAWEAH DELTA HOME HEALTH AGENCY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057F
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Termination Date
Termination Reason
4/1/2025
Other
Contacts
Authorizing Official
Kaweah Delta Health Care District DBA Kaweah Health
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Primary Contact
Kaweah Delta Health Care District DBA Kaweah Health
Allison E Gonzalez, Pharmacy Business Manager
(559) 624-5328
Addresses
Street Address
403 West Main Street
VISALIA, CA 93292
Billing Address
Kaweah Delta Health Care District dba Kaweah Health - Visalia, CA
400 W. Mineral King Ave.
Visalia, CA 93291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date7/1/2005, Termination 4/1/2018, Reinstatement 1/1/2025
10/14/2024
April 2025
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