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DSH050039H ENLOE MEDICAL CENTER (Active)
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Main Details
Name
ENLOE MEDICAL CENTER
Subdivision Name
Enloe Anticoagulation Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050039H
Medicare Provider Number
050039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/6/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/21/2016
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Enloe Medical Center
Kevin Woodward, VP/Chief Financial Officer
(530) 332-6733
Primary Contact
Enloe Medical Center
Renee Thacker, Director, Finance
(530) 332-7386
Addresses
Street Address
888 LAKESIDE VLG COMMONS Bldg A
CHICO, CA 95928-3979
Billing Address
Enloe Medical Center
1531 Esplanade
Chico, CA 95926
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/21/16 Participated starting 10/1/2015, terminated 10/1/2016. Reinstated 1/1/2017.
10/21/2016
April 2025
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