340B Drug Pricing Program Database
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CAH051317-00 Adventist Health Clearlake Hospital, Inc. (Active)
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Main Details
Name
Adventist Health Clearlake Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051317-00
Medicare Provider Number
051317
Additional Details
Current Program Status
Active
Registration Date
8/24/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/22/2011
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Adventist Health North Coast Network
Jeff Mock, Finance Officer, North Coast Network
(916) 406-1417
Primary Contact
St Helena Hospital Clearlake
Jacarre Shelton, Director of Pharmacy
(707) 995-5800
Addresses
Street Address
15630 18th Ave - Hwy 53
Clearlake, CA 95422
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/17/12-Updated addr(was 15630 18th Ave)
02/17/2012
February 2025
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