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DSH050599AL UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
PHYSICAL MEDICINE AND REHABILITATION OCCUPATIONAL THERAPY CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599AL
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
8/26/2014
Termination Date
Termination Reason
10/1/2015
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
2825 J STREET
Suite 400
Sacramento, CA 95817
Billing Address
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
2315 Stockton Blvd
Sacramento, CA 95817
Comments
Medicaid Billing
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Contract Pharmacies
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