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DSH050057AD Kaweah Delta Health Care District DBA Kaweah Health (Active)
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Main Details
Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
Kaweah Health Neurosciences Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057AD
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Contacts
Authorizing Official
Kaweah Delta Health Care District DBA Kaweah Health
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Primary Contact
Kaweah Delta Health Care District DBA Kaweah Health
Allison E Gonzalez, Pharmacy Business Manager
(559) 624-5328
Addresses
Street Address
325 South Willis
Suite 202
Visalia, CA 93291
Billing Address
Kaweah Delta Health Care District DBA Kaweah Health
400 West Mineral King Avenue
Visalia, CA 93291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date4/1/2019, Termination 7/1/2023, Reinstatement 1/1/2025
10/14/2024
April 2025
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