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DSH050599BX UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
ANESTHESIOLOGY / ANESTHESIOLOGY GLASSROCK
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599BX
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
11/27/2017
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
University of California, Davis
TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
2521 STOCKTON BLVD, STE 5200
SACRAMENTO, CA 95817
Billing Address
UNIVERSITY OF CALIFORNIA - DAVIS MEDICAL CENTER
2315 STOCKTON BLVD
SACRAMENTO, CA 95817
Comments
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