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CAH051337-05 HAZEL HAWKINS MEM. HOSPITAL (Active)
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Main Details
Name
HAZEL HAWKINS MEM. HOSPITAL
Subdivision Name
Hazel Hawkins Health Clinic - RHC
Type
Critical Access Hospital
Rural
No
340B ID
CAH051337-05
Medicare Provider Number
051337
Outpatient Facility Provider Number
058590
Additional Details
Current Program Status
Active
Registration Date
7/13/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/20/2021
Last Recertification Date
8/17/2024
Contacts
Authorizing Official
Hazel Hawkins Memorial Hospital
MARK ROBINSON, CFO
(831) 636-2604
Primary Contact
Hazel Hawkins Memorial Hospital
Sandra Dilaura, Controller
(831) 636-2659
Addresses
Street Address
301 The Alameda Suite B-3
San Juan Bautista, CA 95045
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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