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DSH050557E Sutter Valley Hospitals DBA Memorial Medical Center (Active)
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Main Details
Name
Sutter Valley Hospitals DBA Memorial Medical Center
Subdivision Name
Memorial Medical Center Modesto - Infusion Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050557E
Medicare Provider Number
050557
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/11/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/13/2023
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Sutter Health
David Scott Wartelle, CFO - Greater Central Valley Market
(209) 572-7009
Primary Contact
Sutter Health
Rachel L Dunbar, 340B Analyst
(916) 952-3480
Addresses
Street Address
1800 Coffee Rd
Suite #52
Modesto, CA 95355
Billing Address
Sutter Shared Services
P. O. Box 619110
Accounts Payable
Roseville, CA 95661
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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