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DSH050057Z Kaweah Delta Health Care District DBA Kaweah Health (Active)
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Main Details
Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
Kaweah Health Imaging & Breast Center (Breast)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057Z
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/9/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/19/2015
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Kaweah Delta Health Care District DBA Kaweah Health
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Primary Contact
Kaweah Delta Health Care District DBA Kaweah Health
Allison E Gonzalez, Pharmacy Business Manager
(559) 624-5328
Addresses
Street Address
4949 West Cypress Avenue
Visalia, CA 93277-1591
Billing Address
Kaweah Delta Health Care District DBA Kaweah Health
400 West Mineral King Avenue
Visalia, CA 93291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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