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DSH050492E Fresno Community Hospital & Medical Center dba Clovis Community Medical Center (Active)
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Main Details
Name
Fresno Community Hospital & Medical Center dba Clovis Community Medical Center
Subdivision Name
Community Cancer Institute - Infusion Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050492E
Medicare Provider Number
050492
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/1/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/2/2019
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Community Medical Center
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Primary Contact
Community Medical Center
Marcela Magallon, 340B Manager
(559) 244-1387
Addresses
Street Address
785 N. Medical Center DR. West
305
Clovis, CA 93611
Billing Address
Community Regional Medical Center
P.O. Box 1232
Fresno, CA 93715-1231
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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