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ADVENTIST HEALTH HOWARD MEMORIAL
DSH050301 ADVENTIST HEALTH UKIAH VALLEY
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Covered Entity Details
Entity Name
ADVENTIST HEALTH UKIAH VALLEY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050301
Entity Address
275 HOSPITAL DRIVE
UKIAH, CA 95482
Medicare Provider Number
050301
Participating Start Date
1/1/2007
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
ADVENTIST HEALTH HOWARD MEMORIAL
Pharmacy Address
3 MARCELA DR STE B
WILLITS, CA 95490-5769
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/13/2021
Ownership change
Contacts
Covered Entity Signing Official
Ryan Quattlebaum, CFO
(707) 463-7637
Contract Pharmacy Representative
Adventist Health Howard Memorial
Carrie Lynn Winter, Manager Pharmacy-Outpatient
(707) 456-3005
Signed By Date
10/15/2018
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