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DSH050599BB UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
DERMATOLOGY CLINIC AT FOLSOM
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599BB
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/16/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/26/2012
Last Recertification Date
8/17/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
University of California, Davis
TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055
Primary Contact
UC Davis Medical Center
JOHN GRUBBS, DIRECTOR PHARMACY
(916) 734-3305
Addresses
Street Address
1370 Prairie City Road
Folsom, CA 95630-9554
Billing Address
UNIVERSITYOF CALIFORNIA DAVIS MEDICAL CENTER
2315 Stockton Blvd
Sacramento, CA 95817
Comments
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