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DSH050394D CMH OF SAN BUENAVENTURA (Active)
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Main Details
Name
CMH OF SAN BUENAVENTURA
Subdivision Name
CMH Centers for Family Health-Fillmore - Primary Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050394D
Medicare Provider Number
050394
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/4/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/24/2019
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Community Memorial Health System
James A Corwin, Chief Financial Officer
(805) 948-5003
Primary Contact
Community Memorial Health System
Jacek Tretko, Director of Pharmacy Services
(805) 652-5068
Addresses
Street Address
852 W Ventura Road
Fillmore, CA 93015-1837
Billing Address
Community Memorial Health System
147 N Brent St
Ventura, CA 93003
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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