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DSH050122K DAMERON HOSPITAL ASSOCIATION (Terminated)
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Main Details
Name
DAMERON HOSPITAL ASSOCIATION
Subdivision Name
Pacific Heart & Vascular Medical Group
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050122K
Medicare Provider Number
050122
Outpatient Facility Provider Number
017223
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/19/2016
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
1/1/2021
Other
Contacts
Authorizing Official
Dameron Hospital
Timothy Karagounis, Operations Executive
(209) 461-7596 Ext: 2092007800
Primary Contact
Dameron Hospital
Mai Ngoc Trinh, Dameron's Linacia Pharmacy Manager, Pharmacist in Charge
(209) 242-7039
Addresses
Street Address
1801 E. March Lane Suite D400
Stockton, CA 95210
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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