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CRESCENT HEALTHCARE, INC.
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
CRESCENT HEALTHCARE, INC.
Pharmacy Address
25901 INDUSTRIAL BLVD BLDG E
HAYWARD, CA 94545-2995
Pharmacy Comments
Contract Details
Approval Date
1/21/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/4/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Aaron Poole, CFO
(707) 463-7637
Contract Pharmacy Representative
Option Care
Jon Adair, Vice President, Health System Solutions
(847) 830-9996
Signed By Date
1/21/2016
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