340B Drug Pricing Program Database
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DSH050492A Fresno Community Hospital & Medical Center dba Clovis Community Medical Center (Terminated)
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Main Details
Name
Fresno Community Hospital & Medical Center dba Clovis Community Medical Center
Subdivision Name
Community Physical Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050492A
Medicare Provider Number
050492
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/3/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/26/2013
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Community Medical Center
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Primary Contact
Community Medical Center
Joel Weber, Director of Finance -Pharmacy and 340B
(559) 231-1504
Addresses
Street Address
729 Medical Center Drive West Ste 121
Clovis, CA 93612
Billing Address
Clovis Community Medical Center
2755 Herndon Ave.
Clovis, CA 93612
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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