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DSH050276K CONTRA COSTA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
CONTRA COSTA REGIONAL MEDICAL CENTER
Subdivision Name
Willow Pass Wellness Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050276K
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
9/8/2022
Termination Date
Termination Reason
10/1/2023
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
WILLOW PASS WELLNESS CENTER
1420 Willow Pass Rd
Concord, CA 94520-5823
Billing Address
Contra Costa Regional Medical Center
Health Services Finance Administration
50 Douglas Drive, Suite 310
Martinez, CA 94553-4098
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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