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DSH050122A DAMERON HOSPITAL ASSOCIATION (Terminated)
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Main Details
Name
DAMERON HOSPITAL ASSOCIATION
Subdivision Name
Dameron Hospital Occupational Health
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050122A
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
8/29/2022
Termination Date
Termination Reason
10/1/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Dameron Hospital
Timothy Karagounis, Operations Executive
(209) 461-7596 Ext: 2092007800
Primary Contact
Dameron Hospital Association
Sandra Atwater, Director, Pharmacy Services
(209) 339-7555
Addresses
Street Address
2021 West March Lane
Suite #3
Stockton, CA 95207
Billing Address
Dameron Hospital
525 West Acacia St
Stockton, CA 95203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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