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DSH050057V KAWEAH DELTA MEDICAL CENTER (Terminated)
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Main Details
Name
KAWEAH DELTA MEDICAL CENTER
Subdivision Name
KAWEAH DELTA SPECIALTY CLINICS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057V
Medicare Provider Number
050057
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
9/1/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Kaweah Delta Health Care District
GARY K. HERBST, Chief Executive Officer
(559) 624-2330
Primary Contact
Kaweah Delta Health Care District
Catherine Abercrombie, Pharmacy Business Coordinator
(559) 624-4529
Addresses
Street Address
403 W MAIN ST
VISALIA, CA 93291-6240
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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