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SCH050279-00 Hi-Desert Memorial Health Care District (Terminated)
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Main Details
Name
Hi-Desert Memorial Health Care District
Subdivision Name
Hi-Desert Medical Center
Type
Sole Community Hospital
Rural
No
340B ID
SCH050279-00
Medicare Provider Number
050279
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/14/2013
Last Recertification Date
9/10/2015
Termination Date
Termination Reason
10/1/2015
Failure to recertify
Contacts
Authorizing Official
Robert C. Tyk, Chief Finance Officer
(760) 366-6421
Primary Contact
Robert C. Tyk, Chief Finance Officer
(760) 366-6421
Addresses
Street Address
6601 White Feather Road
Joshua Tree, CA 92252-6607
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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