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DSH050599AN UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
OPHTHALMOLOGY CLINIC AT UCDMG ROSEVILLE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599AN
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
8/17/2016
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
2261 Douglas Blvd
Suite 232
Roseville, CA 95661
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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