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DSH050060AH COMMUNITY REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
COMMUNITY REGIONAL MEDICAL CENTER
Subdivision Name
Clinic Prompt Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050060AH
Medicare Provider Number
050060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/12/2017
Last Recertification Date
11/20/2017
Termination Date
Termination Reason
7/1/2018
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Community Medical Center
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Primary Contact
Community Medical Center
Joel Weber, Director of Finance -Pharmacy and 340B
(559) 231-1504
Addresses
Street Address
290 N. Wayte Lane Ste 1800
Fresno, CA 93701
Billing Address
Community Regional Medical Center
P.O. Box 1232
Fresno, CA 93715-1231
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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