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CAH051310-01 Willits Hospital Inc., DBA Adventist Health Howard Memorial (Active)
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Main Details
Name
Willits Hospital Inc., DBA Adventist Health Howard Memorial
Subdivision Name
Adventist Health Howard Memorial
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051310-01
Medicare Provider Number
051310
Outpatient Facility Provider Number
058680
Additional Details
Current Program Status
Active
Registration Date
7/13/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/28/2015
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Adventist Health North Coast Network
Jeff Mock, Finance Officer, North Coast Network
(916) 406-1417
Primary Contact
Adventist Health Ukiah Valley
Tracy Dolmage, Pharmacy Analyst
(707) 463-7633
Addresses
Street Address
3 Marcela Drive, Suite C
Willits, CA 95490-5769
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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