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SCH050335-31 SONORA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
SONORA REGIONAL MEDICAL CENTER
Subdivision Name
ANGELS CAMP ORTHOPEDICS
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH050335-31
Medicare Provider Number
050335
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/13/2014
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
4/1/2017
Change of covered entity type
Contacts
Authorizing Official
Sonora Regional Medical Center
Andrew Jahn, PRESIDENT/CEO
(209) 536-5012
Primary Contact
Ashley Pedroni, 340B Program Specialist
(209) 536-3704
Addresses
Street Address
23 NORTH MAIN
ANGELS CAMP, CA 95222
Billing Address
SONORA COMMUNITY HOSPITAL DBA SONORA REGIONAL MEDICAL CENTER
1000 GREENLEY ROAD
SONORA, CA 95370
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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