340B Drug Pricing Program Database
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DSH050599AF UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
MRI AT AMBULATORY CARE CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599AF
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/3/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/26/2012
Last Recertification Date
8/22/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
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
4860 Y STREET
Suite 0500
Sacramento, CA 95817
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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