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DSH050296 HAZEL HAWKINS MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
HAZEL HAWKINS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050296
Medicare Provider Number
050296
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/16/2018
Last Recertification Date
8/26/2019
Termination Date
Termination Reason
10/1/2020
Failure to recertify
Contacts
Authorizing Official
Hazel Hawkins Memorial Hospital
MARK ROBINSON, CFO
(831) 636-2604
Primary Contact
Hazel Hawkins Memorial Hospital
Karen Gambetta, Controller
(831) 635-1138
Addresses
Street Address
911 SUNSET DRIVE
HOLLISTER, CA 95023
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (04/01/2010) until terminated effective date (10/1/2015), reinstatement date effective (04/01/2018) 4/1/2010)
01/16/2018
May 2025
May 2025
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