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CAH051328-01 TAHOE FOREST HOSPITAL (Terminated)
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Main Details
Name
TAHOE FOREST HOSPITAL
Subdivision Name
Tahoe Forest Health Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051328-01
Medicare Provider Number
051328
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/15/2014
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
7/1/2021
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
TAHOE FOREST HOSPITAL DISTRICT
CRYSTAL BETTS, CHIEF FINANCIAL OFFICER
(530) 582-6656
Primary Contact
TAHOE FOREST HOSPITAL DISTRICT
TENA MATHER, DIRECTOR OF PHARMACY
(530) 582-6465
Addresses
Street Address
10956 DONNER PASS RD, STE 230
TRUCKEE, CA 96161
Billing Address
TAHOE FOREST HOSPITAL DISTRICT
P.O. BOX 759
TRUCKEE, CA 96160
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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