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CAH051325-01 ADVENTIST HEALTH MENDOCINO COAST (Active)
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Main Details
Name
ADVENTIST HEALTH MENDOCINO COAST
Subdivision Name
AH Fort Bragg Mendocino Coast RHC
Type
Critical Access Hospital
Rural
No
340B ID
CAH051325-01
Medicare Provider Number
051325
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/17/2016
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Adventist Health North Coast Network
Jeff Mock, Finance Officer, North Coast Network
(916) 406-1417
Primary Contact
Adventist Health Ukiah Valley
Tracy Dolmage, Pharmacy Analyst
(707) 463-7633
Addresses
Street Address
721 River Drive
Suites A, B and C
Fort Bragg, CA 95437
Billing Address
ADVENTIST HEALTH MENDOCINO COAST
700 River Drive
Fort Bragg, CA 95437
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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