340B Drug Pricing Program Database
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DSH050276Q CONTRA COSTA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
CONTRA COSTA REGIONAL MEDICAL CENTER
Subdivision Name
Antioch Healthy Start
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050276Q
Medicare Provider Number
050276
Outpatient Facility Provider Number
050276
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/17/2013
Last Recertification Date
9/7/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Contra Costa Health
Patrick Godley, Chief Operating Officer and Chief Financial Officer
(925) 957-5405
Primary Contact
Contra Costa Health
Robert H De Cesare, Fiscal Manager
(925) 957-5429
Addresses
Street Address
Antioch Healthy Start
1104 Buchanan Rd, Suite C-10A
Antioch, CA 94509-4205
Billing Address
Contra Costa Regional Medical Center Outpatient Pharmacy
2500 Alhambra Ave
Building 1
Martinez, CA 94553-3156
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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