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CAH051317-12 Adventist Health Clearlake Hospital, Inc. (Active)
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Main Details
Name
Adventist Health Clearlake Hospital, Inc.
Subdivision Name
Hilltop RHC Family Medicine & Specialty - Family Medicine, General Surgery & Cardiology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051317-12
Medicare Provider Number
051317
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/13/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/20/2022
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Adventist Health North Coast Network
Jeff Mock, Finance Officer, North Coast Network
(916) 406-1417
Primary Contact
St Helena Hospital Clearlake
Jacarre Shelton, Director of Pharmacy
(707) 995-5800
Addresses
Street Address
15322 Lakeshore Dr
Suite 101 102 201
Clearlake, CA 95422
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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