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DSH050599CB UC DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UC DAVIS MEDICAL CENTER
Subdivision Name
Ophthalmology Clinic / Ophthalmology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599CB
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
8/17/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
University of California, Davis
TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055
Primary Contact
JOHN GRUBBS, DIRECTOR OF PHARMACY
(916) 734-3305
Addresses
Street Address
251 Turnpike Dr, Ste 1070
Folsom, CA 95630
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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