340B Drug Pricing Program Database
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DSH050133D RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout (Terminated)
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Main Details
Name
RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
Subdivision Name
Feather River Clinic - Primary Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050133D
Medicare Provider Number
050133
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/10/2019
Participating Start Date
5/14/2019
Participating Approval Date
5/14/2019
Last Recertification Date
8/30/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Rideout Memorial Hospital
Ed Gonzalez, CFO
(530) 751-4010
Primary Contact
Rideout Health
Israel Camacho, 340B Program Coordinator
(559) 723-2514
Addresses
Street Address
5125 Skyway
Paradise, CA 95969
Billing Address
Adventist Health and Rideout
726 4th Street
Marysville, CA 95901
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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