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DSH050599CY UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Cancer Center Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599CY
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/5/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/25/2016
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
UC Davis Health
Jennifer L Doll, Chief Financial Officer
(916) 708-2708
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
4501 X Street
Suite 2000
SACRAMENTO, CA 95817
Billing Address
UC DAVIS MEDICAL CENTER
PO Box 168016
SACRAMENTO, CA 95816
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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