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DSH050557A Sutter Valley Hospitals DBA Memorial Medical Center (Active)
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Main Details
Name
Sutter Valley Hospitals DBA Memorial Medical Center
Subdivision Name
Outpatient Services-Trauma Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050557A
Medicare Provider Number
050557
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/12/2014
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Sutter Health
David Scott Wartelle, CFO - Greater Central Valley Market
(209) 572-7009
Primary Contact
Sutter Health
Rachel L Dunbar, 340B Analyst
(916) 952-3480
Addresses
Street Address
1401 Spanos Ct
Suite 127
Modesto, CA 95355
Billing Address
Memorial Medical Center
Sutter Shared Services Accounts Payable
PO Box 619110
Roseville, CA 95661
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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