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DSH050599BY UC DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UC DAVIS MEDICAL CENTER
Subdivision Name
UNIVERSITY WOMENS CLINIC / BREAST HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599BY
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/30/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
Last Recertification Date
8/17/2016
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
University of California, Davis
TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055
Primary Contact
UC Davis Medical Center
JOHN GRUBBS, DIRECTOR PHARMACY
(916) 734-3305
Addresses
Street Address
4860 Y STREET, STE 0540
SACRAMENTO, CA 95817
Billing Address
UNIVERSITY OF CALIFORNIA - DAVIS MEDICAL CENTER
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Comments
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