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DSH050057Q Kaweah Delta Health Care District DBA Kaweah Health (Active)
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Main Details
Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
SEQUOIA REGIONAL CANCER CENTER (RADIATION ONCOLOGY)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057Q
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Contacts
Authorizing Official
Kaweah Delta Health Care District DBA Kaweah Health
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Primary Contact
Kaweah Delta Health Care District DBA Kaweah Health
Allison E Gonzalez, Pharmacy Business Manager
(559) 624-5328
Addresses
Street Address
4945 W. CYPRESS AVE., SUITE A
VISALIA, CA 93277-1592
Billing Address
Kaweah Delta Health Care District
400 W. Mineral King Ave
Visalia, CA 93291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date4/8/2013, Termination 10/1/2021, Reinstatement 1/1/2025
10/14/2024
April 2025
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