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DSH050060AL COMMUNITY REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
COMMUNITY REGIONAL MEDICAL CENTER
Subdivision Name
Community Dialysis Center - Clovis - Dialysis
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050060AL
Medicare Provider Number
050060
Outpatient Facility Provider Number
053529
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/5/2021
Last Recertification Date
8/26/2022
Termination Date
Termination Reason
7/1/2023
Site closure
Contacts
Authorizing Official
Community Medical Center
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844
Primary Contact
Community Medical Center
Joel Weber, Director of Finance -Pharmacy and 340B
(559) 231-1504
Addresses
Street Address
501 N. Medical Center Drive East
Suite 1100
Clovis, CA 93619
Billing Address
Community Regional Medical Center
P.O. Box 1232
Fresno, CA 93715
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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