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DSH050599BD UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
J STREET MEDICAL SPECIALTY CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599BD
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/6/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/9/2018
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
UC Davis Health
Jennifer L Doll, Chief Financial Officer
(916) 708-2708
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
2825 J Street
Suite 400
Sacramento, CA 95816
Billing Address
UC Davis Medical Center Accounts Payable
PO Box 168016
Sacramento, CA 95816
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participation started on 7/1/2012; Terminated 1/1/2018; Reinstated 7/1/2018.
04/20/2018
Participated starting 7/1/2012; Terminated 1/1/2018; Reinstated 2/20/2018.
02/20/2018
April 2025
April 2025
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