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DSH050599DC UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
SURGERY PEDIATRIC GLASSROCK
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599DC
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/13/2017
Last Recertification Date
8/22/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
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
2521 STOCKTON BLVD
Suite 4100
SACRAMENTO, CA 95817
Billing Address
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
PO Box 168016
SACRAMENTO, CA 95816
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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