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SCH050335-26 ADVENTIST HEALTH SONORA (Terminated)
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Main Details
Name
ADVENTIST HEALTH SONORA
Subdivision Name
Sonora Regional Surgery Center
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH050335-26
Medicare Provider Number
050335
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2024
Participating Start Date
7/1/2024
Participating Approval Date
6/3/2024
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
905 Morningstar Drive
Sonora, CA 95370
Billing Address
Sonora Community Hospital DBA Adventist Health Sonora
1000 Greenley Road
Sonora, CA 95370
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 4/1/2012, Termination Date 4/1/2017, Reinstatement 7/1/2024
04/10/2024
May 2025
May 2025
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