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DSH050057AJ Kaweah Delta Health Care District DBA Kaweah Health (Active)
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Main Details
Name
Kaweah Delta Health Care District DBA Kaweah Health
Subdivision Name
Kaweah Health Dialysis Center - CAPD/CCPD Training Services - Dialysis Center - CAPD/CCPD Training Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057AJ
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/11/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/26/2022
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Kaweah Delta Health Care District DBA Kaweah Health
Gary K Herbst, Chief Executive Officer
(559) 624-2330
Primary Contact
Kaweah Delta Health Care District DBA Kaweah Health
Allison E Gonzalez, Pharmacy Business Manager
(559) 624-5328
Addresses
Street Address
5040 West Tulare Avenue
Visalia, CA 93277
Billing Address
Kaweah Delta Health Care District DBA Kaweah Health
400 West Mineral King Avenue
Visalia, CA 93291
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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