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DSH050336 Adventist Health Lodi Memorial (Active)
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Main Details
Name
Adventist Health Lodi Memorial
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050336
Medicare Provider Number
050336
Additional Details
Current Program Status
Active
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/23/2015
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Adventist Health Lodi Memorial
Katie Delmore, Finance Officer
(916) 406-1123
Primary Contact
Adventist Health Lodi Memorial
Tin Nguyen, Director of Pharmacy
(209) 339-7555
Addresses
Street Address
975 S. FAIRMONT AVENUE
LODI, CA 95240
Billing Address
Adventist Health Lodi Memorial
P O Box 3004
Lodi, CA 95241
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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