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SCH050335-21 SONORA COMMUNITY HOSPITAL DBA SONORA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
SONORA COMMUNITY HOSPITAL DBA SONORA REGIONAL MEDICAL CENTER
Subdivision Name
SONORA REGIONAL HOME HEALTH
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH050335-21
Medicare Provider Number
050335
Outpatient Facility Provider Number
557561
Additional Details
Current Program Status
Terminated
Registration Date
6/21/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/22/2011
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
4/1/2017
Change of covered entity type
Contacts
Authorizing Official
Sonora Regional Medical Center
Andrew Jahn, PRESIDENT/CEO
(209) 536-5012
Primary Contact
Ashley Pedroni, 340B Program Specialist
(209) 536-3704
Addresses
Street Address
20100 CEDAR ROAD NORTH
SONORA, CA 95370
Billing Address
SONORA COMMUNITY HOSPITAL DBA SONORA REGIONAL MEDICAL CENTER
1000 GREENLEY ROAD
SONORA, CA 95370
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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