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DSH050121R Adventist Medical Center (Terminated)
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Main Details
Name
Adventist Medical Center
Subdivision Name
Wound Healing Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050121R
Medicare Provider Number
050121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/29/2015
Last Recertification Date
9/3/2024
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
Adventist Health
Timothy Michael Haydock, CFO
(559) 537-0050
Primary Contact
Adventist Health
Ahmed Abukhazneh, Pharmacist, Charge
(559) 537-2190
Addresses
Street Address
125 Mall Drive
Hanford, CA 93230
Billing Address
Adventist Medical Center Hanford
115 Mall Drive
Hanford, CA 93230
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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