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CAH051319-00 DIGNITY HEALTH D/B/A MERCY MEDICAL CENTER MT. SHASTA (Active)
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Main Details
Name
DIGNITY HEALTH D/B/A MERCY MEDICAL CENTER MT. SHASTA
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051319-00
Medicare Provider Number
051319
Additional Details
Current Program Status
Active
Registration Date
8/20/2010
Participating Start Date
9/8/2010
Participating Approval Date
8/23/2010
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Dignity Health
Rob Lowes, CFO
(530) 225-6390
Primary Contact
Dignity Health Mercy Medical Center Mt. Shasta
Natalie Codianne, Director of Pharmacy
(530) 926-7217
Addresses
Street Address
914 PINE STREET.
MOUNT SHASTA, CA 96067
Billing Address
Dignity Health AP SAC
3400 Data Drive
3rd floor
Rancho Cordova, CA 95670
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/30/12 - Updated entity name (was CATHOLIC HEALTHCARE WEST D/B/A MERCY MEDICAL CENTER MT. SHASTA)
03/30/2012
May 2025
May 2025
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