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SCH050133-00 RIDEOUT MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
RIDEOUT MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH050133-00
Medicare Provider Number
050133
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
Last Recertification Date
Termination Date
Termination Reason
7/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Rideout Health
Diane Moon, CFO
(530) 751-4260
Primary Contact
Rideout Health
Jerry Gonzales, Director of Pharmacy
(530) 749-4401
Addresses
Street Address
726 4TH STREET
MARYSVILLE, CA 95901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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