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DSH050599CE UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Pediatric IV Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599CE
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/8/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/28/2015
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
UC Davis Health
Jennifer L Doll, Chief Financial Officer
(916) 708-2708
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
2279 45th St
Cancer Center 1st Floor North Building
Sacramento, CA 95817
Billing Address
UC Davis Medical Center
PO Box 168016
Sacramento, CA 95816
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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