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DSH050039AF ENLOE MEDICAL CENTER (Terminated)
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Main Details
Name
ENLOE MEDICAL CENTER
Subdivision Name
Urogynecology (708016/718016)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050039AF
Medicare Provider Number
050039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/8/2022
Last Recertification Date
8/31/2023
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
Enloe Medical Center
Kevin Woodward, VP/Chief Financial Officer
(530) 332-6733
Primary Contact
Enloe Medical Center
Renee Thacker, Director, Finance
(530) 332-7386
Addresses
Street Address
1423 Magnolia Avenue
Chico, CA 95926
Billing Address
Enloe Medical Center
1531 Esplanade
Chico, CA 95926
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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