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CAH051325-00 ADVENTIST HEALTH MENDOCINO COAST (Active)
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Main Details
Name
ADVENTIST HEALTH MENDOCINO COAST
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH051325-00
Medicare Provider Number
051325
Additional Details
Current Program Status
Active
Registration Date
8/10/2010
Participating Start Date
8/11/2010
Participating Approval Date
8/10/2010
Last Recertification Date
8/19/2024
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
700 RIVER DRIVE
FORT BRAGG, CA 95437
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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