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CAH051332-00 Mark Twain Medical Center (Active)
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Main Details
Name
Mark Twain Medical Center
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051332-00
Medicare Provider Number
051332
Additional Details
Current Program Status
Active
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/14/2013
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Mark Twain Medical Center
Doug Archer, President/CEO
(209) 754-5916
Primary Contact
Mark Twain Medical Center
Jill Ortiz, Director of Pharmacy
(209) 754-2464
Addresses
Street Address
768 Mountain Ranch Road
San Andreas, CA 95249
Billing Address
Dignity Health AP SAC
3400 Data Drive
Rancho Cordova, CA 95670
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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