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CAH051321-04 NorCal HealthConnect LLC- DBA Healdsburg Hospital (Active)
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Main Details
Name
NorCal HealthConnect LLC- DBA Healdsburg Hospital
Subdivision Name
Healdsburg Hospital Behavioral Health Services
Type
Critical Access Hospital
Rural
No
340B ID
CAH051321-04
Medicare Provider Number
051321
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/31/2020
Participating Start Date
10/1/2020
Participating Approval Date
9/9/2020
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Providence St Joseph Health
Erika Wright, CFO
(707) 525-5300
Primary Contact
Providence
Jesse Peterson, 340B Program Director, South Division
(651) 324-2207
Addresses
Street Address
1312 Prentice Drive
Healdsburg, CA 95448
Billing Address
Healdsburg Hospital
1375 University Avenue
Healdsburg, CA 95448
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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