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DSH050599DJ UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
GYNECOLOGY CLINIC - Midtown OB
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599DJ
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/6/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/3/2018
Last Recertification Date
8/26/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
University of California, Davis
TIMOTHY MAURICE, CHIEF FINANCIAL OFFICER
(916) 734-4055
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
3160 Folsom Blvd
Suite 3900
Sacramento, CA 95816
Billing Address
UC Davis Medical Center
2315 Stockton Blvd
Sacramento, CA 95817
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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