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DSH050557C Sutter Valley Hospitals DBA Memorial Medical Center (Active)
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Main Details
Name
Sutter Valley Hospitals DBA Memorial Medical Center
Subdivision Name
Memorial Hospital Modesto MRI - MRI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050557C
Medicare Provider Number
050557
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/5/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Sutter Health
David Scott Wartelle, CFO - Greater Central Valley Market
(209) 572-7009
Primary Contact
Sutter Health
Rachel L Dunbar, 340B Analyst
(916) 952-3480
Addresses
Street Address
1700 Coffee Road
Modesto, CA 95355
Billing Address
Sutter Shared Services
Accounts Payable
P.O. Box 619110
Roseville, CA 95661
Comments
Medicaid Billing
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Contract Pharmacies
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