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DSH050492D Fresno Community Hospital & Medical Center dba Clovis Community Medical Center (Active)
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Main Details
Name
Fresno Community Hospital & Medical Center dba Clovis Community Medical Center
Subdivision Name
Wound Care Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050492D
Medicare Provider Number
050492
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/13/2014
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Community Medical Center
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Primary Contact
Community Medical Center
Marcela Magallon, 340B Manager
(559) 244-1387
Addresses
Street Address
688 Medical Center Drive East
Suite 101
Clovis, CA 93611
Billing Address
Community Regional Medical Center
P.O. Box 1232
Fresno, CA 93715-1231
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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