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DSH050122B DAMERON HOSPITAL ASSOCIATION (Terminated)
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Main Details
Name
DAMERON HOSPITAL ASSOCIATION
Subdivision Name
Dameron Hospital Association Sweet Success
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050122B
Medicare Provider Number
050122
Outpatient Facility Provider Number
050122
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/12/2013
Last Recertification Date
8/26/2016
Termination Date
Termination Reason
1/1/2018
Site closure
Contacts
Authorizing Official
Dameron Hospital
Timothy Karagounis, Operations Executive
(209) 461-7596 Ext: 2092007800
Primary Contact
Gerald Downs, Director of Pharmacy
(209) 461-3129
Addresses
Street Address
530 West Acacia St
Suite 25
Stockton, CA 95203
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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