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DSH050599CC UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Speech Pathology / PM&R Speech Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599CC
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/28/2015
Last Recertification Date
9/1/2020
Termination Date
Termination Reason
10/1/2021
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
4860 Y Street
Suite 1100
Sacramento, CA 95817
Billing Address
UC Davis Medical Center
2315 Stockton Blvd
Sacramento, CA 95817
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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