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SCH050335-00 ADVENTIST HEALTH SONORA (Terminated)
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Main Details
Name
ADVENTIST HEALTH SONORA
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH050335-00
Medicare Provider Number
050335
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/30/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Adventist Health Sonora
Greg McCulloch, President
(209) 536-5012
Primary Contact
Adventist Health Sonora
Ashley Pedroni, 340B Program Compliance Analyst
(209) 536-3704
Addresses
Street Address
1000 GREENLEY ROAD
SONORA, CA 95370
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Start date 7/1/2011, Termination 4/1/2017, Reinstatement 7/1/2024
04/30/2024
April 2025
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