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DSH050599DU UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
Subdivision Name
Pain Service Clinic - AIM Services Glassrock
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050599DU
Medicare Provider Number
050599
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/9/2022
Last Recertification Date
8/22/2024
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
UC Davis Health
Jennifer L Doll, Chief Financial Officer
(916) 708-2708
Primary Contact
UC Davis Medical Center
Mark Riggle, Assistant Chief Pharmacist
(916) 734-3309
Addresses
Street Address
2521 Stockton Blvd
Suite 3300
Sacramento, CA 95817
Billing Address
UC Davis Medical Center Account Payable
PO Box 168016
Sacramento, CA 95816
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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