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SCH050352-00 BARTON MEMORIAL HOSPITAL (Active)
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Main Details
Name
BARTON MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
No
340B ID
SCH050352-00
Medicare Provider Number
050352
Additional Details
Current Program Status
Active
Registration Date
4/4/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/26/2023
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Barton Healthcare System
Kelly Shea Neiger, CFO
(530) 543-5923
Primary Contact
Barton Healthcare System
Jeffrey Glen Koeck, Director of Pharmacy
(530) 543-5883
Addresses
Street Address
2170 SOUTH AVENUE
SOUTH LAKE TAHOE, CA 96158
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2015; Terminated 10/1/2021; Reinstated 7/1/2023.
04/26/2023
11/17/14 enrolled 7/1/11 thru 9/30/14, not enrolled 10/1/14 thru 12/31/14 due to DSH% falling below the cutoff, re-instated based on on-line registration submitted in October, 2014
11/17/2014
April 2025
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