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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

MENDOCINO COAST DISTRICT HOSPITAL

700 RIVER DRIVE
FORT BRAGG, CA 95437
https://www.adventisthealth.org/

License:

General Acute Care Hospital
Total Beds: 49
Emergency Room: Yes
more... Link to Atlas

Contact:

Amy Miller
503-812-1847

OSHPD ID:

106231013

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

5/11/2023

Download:

Federal Poverty Level for Free Care:

200%

Discount Payment Effective Date:

3/31/2023

Discount Payments

FPL Range: 200%-400%
Payment Basis:
Medicare
Medi-Cal
Other Government Insurance
Other: All payors including goverment payors

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

N/A

Application Form Information

Application Form Eff Date:

11/8/2022

Download:

Income Type Used:

Salary Received
Interest Received

Language Information

Available Languages:

English
Spanish
Vietnamese
Tagalog
Korean
Chinese
Russian
Other: French, German, Japanese

Additional Information

Updated policy

Family Size	100%	150%	200%	250%	300%	350%	400%