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DSH050315G KERN MEDICAL CENTER (Active)
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Main Details
Name
KERN MEDICAL CENTER
Subdivision Name
KERN COUNTY HOSPITAL AUTHORITY - FAMILY PRACTICE CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050315G
Medicare Provider Number
050315
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/22/2019
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Kern Medical Center
Scott Thygerson, Chief Executive Officer
(661) 326-2102
Primary Contact
Kern Medical
Jeffrey Charles Jolliff, Director of Pharmacy
(661) 326-2191
Addresses
Street Address
1111 COLUMBUS STREET
3000
BAKERSFIELD, CA 93305
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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