340B Drug Pricing Program Database
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CAH051317-10 Adventist Health Clearlake Hospital, Inc. (Active)
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Main Details
Name
Adventist Health Clearlake Hospital, Inc.
Subdivision Name
Hidden Valley Multispecialities - Internal Medicine / Primary Care
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051317-10
Medicare Provider Number
051317
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/8/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/15/2019
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Adventist Health North Coast Network
Jeff Mock, Finance Officer, North Coast Network
(916) 406-1417
Primary Contact
St Helena Hospital Clearlake
Jacarre Shelton, Director of Pharmacy
(707) 995-5800
Addresses
Street Address
18990 Coyote Valley Rd
Suite 10
Hidden Valley Lake, CA 95467
Billing Address
Adventist Health Clear Lake
15630 18th Avenue
Clearlake, CA 95422
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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