340B Drug Pricing Program Database


DSH050047H SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS (Terminated) - information as of 6/3/2025 12:03:56 PM

Main Details
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Care
Disproportionate Share Hospital
No
DSH050047H
050047


Additional Details
Terminated
10/15/2014
1/1/2015
12/4/2014
8/22/2023

4/1/2024
Business decision by the Covered Entity

Contacts

California Pacific Medical Center
HENRY YU, VP AND CFO
(415) 600-3850

Sutter Health
Patricia Minger, 340b Analyst
(510) 316-9771

Addresses

2351 CLAY ST FL 6
SAN FRANCISCO, CA 94115-1931

Sutter Shared Services Accounts Payable
PO Box 619110
Roseville, CA 95661


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA95000471780742981,1740348929,1902964109
AL 1740348929,1780742981,1902964109
AK 1740348929,1780742981,1902964109
AZ 1740348929,1780742981,1902964109
CT 1740348929,1780742981,1902964109
DE 1740348929,1780742981,1902964109
DC 1740348929,1780742981,1902964109
FL 1740348929,1780742981,1902964109
GA 1740348929,1780742981,1902964109
HI 1740348929,1780742981,1902964109
KS 1740348929,1780742981,1902964109
ME 1740348929,1780742981,1902964109
MD 1740348929,1780742981,1902964109
MA 1740348929,1780742981,1902964109
MI 1740348929,1780742981,1902964109
MO 1740348929,1780742981,1902964109
MT 1740348929,1780742981,1902964109
NE 1740348929,1780742981,1902964109
NV 1740348929,1780742981,1902964109
NH 1740348929,1780742981,1902964109
NJ 1740348929,1780742981,1902964109
NM 1740348929,1780742981,1902964109
OH 1740348929,1780742981,1902964109
OK 1740348929,1780742981,1902964109
PA 1740348929,1780742981,1902964109
RI 1740348929,1780742981,1902964109
SC 1740348929,1780742981,1902964109
SD 1740348929,1780742981,1902964109
TX 1740348929,1780742981,1902964109
VT 1740348929,1780742981,1902964109
WA 1740348929,1780742981,1902964109
WY 1740348929,1780742981,1902964109
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050047AChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA PACIFIC MEDICAL CENTER CALIFORNIA CAMPUS3700 CALIFORNIA STREETSAN FRANCISCOCATerminated
DSH050047AAChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSOPERATING ROOM - RECOVERY ROOM2333 BUCHANAN STSAN FRANCISCOCATerminated
DSH050047ABChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSELECTROCARDIOLOGY - NON-INVASIVE CARDIO-EKG2333 BUCHANAN STSAN FRANCISCOCATerminated
DSH050047ACChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - CT1100 Van Ness AvenueSan FranciscoCAActive
DSH050047ADChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - X-Ray1100 Van Ness AvenueSan FranciscoCAActive
DSH050047AEChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - MRI1100 Van Ness AvenueSan FranciscoCAActive
DSH050047AFChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - Ultrasound1100 Van Ness AvenueSan FranciscoCAActive
DSH050047AGChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER - B.H. CANCER CARE CENTER-BUCHANAN ST2333 BUCHANAN STREETSan FranciscoCAActive
DSH050047BChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / TRANSPLANT CLINIC1100 VAN NESS AVESAN FRANCISCOCAActive
DSH050047CChildDSHSUTTER BAY HOSPITALS DBAPACIFIC CAMPUS / MRI2351 CLAY ST 100SAN FRANCISCOCATerminated
DSH050047DChildDSHCALIFORNIA PACIFIC MEDICAL CENTERCALIFORNIA PACIFIC MEDICAL CENTER-P / hEART INSTITUTE (CARDIO THORACIC)2340 CLAY ST STE 114A RMS 111 112 114SAN FRANCISCOCATerminated
DSH050047EChildDSHCALIFORNIA PACIFIC MEDICAL CENTERCALIFORNIA PACIFIC MEDICAL CENTER-P / OPHTHOMOLOGY CLINIC2340 CLAY ST FL 5 STE A RMS 503-505 507 512SAN FRANCISCOCATerminated
DSH050047FChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab,RT2351 CLAY STSAN FRANCISCOCATerminated
DSH050047GChildDSHCALIFORNIA PACIFIC MEDICAL CENTERCALIFORNIA PACIFIC MEDICAL CENTER-P / MRI2351 CLAY ST 100SAN FRANCISCOCATerminated
DSH050047HChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Care2351 CLAY ST FL 6SAN FRANCISCOCATerminated
DSH050047JChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / B.H. Cancer Care Center2351 CLAY ST 134SAN FRANCISCOCAActive
DSH050047KChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS WEST / OB TRIAGE3700 CALIFORNIA ST G LEVELSAN FRANCISCOCATerminated
DSH050047LChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA WEST CAMPUS / EMERGENCY DEPARTMENT3700 CALIFORNIA ST G LEVELSAN FRANCISCOCATerminated
DSH050047MChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / SURGERY3700 CALIFORNIA ST FLOOR 3SAN FRANCISCOCATerminated
DSH050047NChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / PACU (RECOVERY ROOM)3700 CALIFORNIA ST FLOOR 3SAN FRANCISCOCATerminated
DSH050047PChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / ANESTHESIA3700 CALIFORNIA ST FLOOR 3SAN FRANCISCOCATerminated
DSH050047QChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / MRI3700 CALIFORNIA ST G350SAN FRANCISCOCATerminated
DSH050047RChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / RESPIRATORY THERAPY3700 CALIFORNIA ST 3FL 375-376SAN FRANCISCOCATerminated
DSH050047SChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / GI LAB3700 CALIFORNIA ST- FLOOR 3SAN FRANCISCOCATerminated
DSH050047TChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA WEST CAMPUS -RADIOLOGY3700 CALIFORNIA STSAN FRANCISCOCATerminated
DSH050047UChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Center for Women's Health Care2333 Buchanan StreetSAN FRANCISCOCAActive
DSH050047VChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / Ambulatory Surgery Unit3700 CALIFORNIA ST- FLOOR 3SAN FRANCISCOCATerminated
DSH050047WChildDSHSUTTER BAY HOSPITALS DBAPacific Campus / Interventional Endoscopy Unit2351 Clay St Fl 6 Suite 600San FranciscoCATerminated
DSH050047XChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSRADIOLOGY - DIAGNOSTIC - RADIATION ONCOLOGY2333 BUCHANAN STSAN FRANCISCOCAActive
DSH050047YChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSOPERATING ROOM - ANESTHESIOLOGY2333 BUCHANAN STSAN FRANCISCOCATerminated
DSH050047ZChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSOPERATING ROOM - SURGERY2333 BUCHANAN STSAN FRANCISCOCATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated4/1/2024 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 1/1/2021 12:00:00 AM3/20/2024 12:47 PM
DetailsStateUpdateTermination RequestActiveTo Be Terminated3/20/2024 12:47 PM
TerminationsTermination CommentsUpdateTermination Request unit was closed during Covid emergency and has never re-opened. no plans to re-open.3/20/2024 12:47 PM
TerminationsTermination DateUpdateTermination Request 4/1/2024 12:00:00 AM3/20/2024 12:47 PM
TerminationsTermination Effective DateUpdateTermination Request 1/1/2021 12:00:00 AM3/20/2024 12:47 PM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity3/20/2024 12:47 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/25/2024 11:23 AM
ContactsPrimary ContactUpdateChange RequestMinger, Patricia Pharmacy Technician Analyst Sutter Health 4156003202Minger, Patricia 340b Analyst Sutter Health 51031697719/19/2023 11:21 AM
DetailsLast Recertification DateUpdateRecertification8/26/2022 10:54:43 AM8/22/2023 2:47:49 PM8/22/2023 2:47 PM
DetailsLast Recertification DateUpdateRecertification8/26/2021 1:04:54 PM8/26/2022 10:54:43 AM8/26/2022 10:54 AM
ContactsPrimary ContactUpdateProfile Change RequestMinger, Patricia Pharmacy Technician Analyst Sutter Health 5106820302Minger, Patricia Pharmacy Technician Analyst Sutter Health 41560032023/31/2022 12:49 PM
ContactsPrimary ContactUpdateGroup Change RequestYu, Collin Pharmacy Manager Sutter Health California Pacific Medical Center 4156028619Minger, Patricia Pharmacy Technician Analyst Sutter Health 51068203023/29/2022 6:48 AM
ContactsPrimary ContactUpdateRecertificationKnaus, Paul Pharmacy IS Manager California Pacific Medical Center 4156003142Yu, Collin Pharmacy Manager Sutter Health California Pacific Medical Center 41560286198/26/2021 1:04 PM
DetailsLast Recertification DateUpdateRecertification9/11/2020 1:51:29 PM8/26/2021 1:04:54 PM8/26/2021 1:04 PM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 1:51 PM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 1:51 PM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 1:51 PM
ContactsPrimary ContactUpdateRecertificationWILLIS, DON PHARMACY PURCH SYSTEMS MANAGER California Pacific Med Ctr 4156003200Knaus, Paul Pharmacy IS Manager California Pacific Medical Center 41560031429/11/2020 1:51 PM
DetailsLast Recertification DateUpdateRecertification8/28/2019 1:44:49 PM9/11/2020 1:51:29 PM9/11/2020 1:51 PM
AddressesBilling AddressInsertRecertification Sutter Shared Services Accounts Payable PO Box 619110 Roseville, CA 956618/28/2019 1:44 PM
DetailsLast Recertification DateUpdateRecertification8/31/2018 12:35:07 PM8/28/2019 1:44:49 PM8/28/2019 1:44 PM
DetailsEntity SubnameUpdateChange RequestCALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory SurgeryCALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Care9/12/2018 3:23 PM
DetailsLast Recertification DateUpdateRecertification11/15/2017 1:25:04 PM8/31/2018 12:35:07 PM8/31/2018 12:35 PM
ContactsSigned ByUpdate GATES, JOHN CFO 4156003932GATES, JOHN CFO Sutter Health 415600393211/17/2017 1:11 PM
DetailsEntity NameUpdateRecertificationCALIFORNIA PACIFIC MEDICAL CENTERSUTTER BAY HOSPITALS DBA11/15/2017 3:20 PM
Medicaid BillingNPI: NumberInsertRecertification 174034892911/15/2017 1:25 PM
Medicaid BillingNPI: NumberInsertRecertification 190296410911/15/2017 1:25 PM
DetailsLast Recertification DateUpdateRecertification8/10/2016 12:00:00 AM11/15/2017 1:25:04 PM11/15/2017 1:25 PM
ContactsAuthorizing OfficialUpdate YU, HENRY VP AND CFO 4156003850YU, HENRY VP AND CFO California Pacific Medical Center 41560038509/20/2017 11:35 AM
ContactsPrimary ContactUpdate WILLIS, DON PHARMACY PURCH SYSTEMS MANAGER 4156003200WILLIS, DON PHARMACY PURCH SYSTEMS MANAGER California Pacific Med Ctr 41560032009/19/2017 4:59 PM
ContactsAuthorizing OfficialInsert  YU, HENRY VP AND CFO 41560038508/9/2017 1:39 PM
ContactsPrimary ContactInsert  WILLIS, DON PHARMACY PURCH SYSTEMS MANAGER 41560032002/21/2017 2:34 PM
AddressesMain AddressInsert   2351 CLAY ST FL 6 SAN FRANCISCO, CA 94115-19312/21/2017 2:34 PM
ContactsSigned ByInsert  GATES, JOHN CFO 41560039322/21/2017 2:34 PM
DetailsEntity SubnameUpdate CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery-IESCALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery1/17/2017 11:44 AM
DetailsLast Recertification DateUpdate 8/6/2015 12:00:00 AM8/10/2016 12:00:00 AM8/10/2016 3:06 PM
Medicaid BillingNPI: NumberInsert  17807429816/24/2016 2:59 AM
DetailsEntity SubnameUpdate CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory SurgeryCALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery-IES1/15/2016 2:49 PM
DetailsLast Recertification DateUpdate  8/6/2015 12:00:00 AM8/6/2015 8:14 AM
DetailsEntity SubnameUpdate CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery / Ambulatory Surgery CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery12/12/2014 11:21 AM
DetailsEntity SubnameUpdate CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery / Ambulatory Surgery 12/4/2014 5:08 PM
DatesParticipating Approval DateUpdate  12/4/2014 12:00:00 AM12/4/2014 5:08 PM
DetailsStateUpdate PendingActive12/4/2014 5:08 PM
DatesStart DateUpdate  1/1/2015 12:00:00 AM12/4/2014 5:08 PM
DetailsEntity SubnameUpdate CALIFORNIA PACIFIC MEDICAL CENTER-PCALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Surgery 10/30/2014 4:25 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REG_47531DSH050047H10/30/2014 3:56 PM
Details340B IDUpdate  OUTPATIENT_ONLINE_REG_4753110/15/2014 2:27 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/15/2014 2:27 PM
Medicaid BillingMedicaid: NumberInsert  950004710/15/2014 2:27 PM
Medicaid BillingMedicaid: StateInsert  CA10/15/2014 2:27 PM
DetailsLast Recertification DateInsert   10/15/2014 2:27 PM
DetailsGrant NumberInsert   10/15/2014 2:27 PM
Details340B IDInsert   10/15/2014 2:27 PM
DetailsIs Authorizing Official EHB DataInsert   10/15/2014 2:27 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/15/2014 2:27 PM
DetailsMedicare Provider NumberInsert  05004710/15/2014 2:27 PM
DetailsEntity NameInsert  CALIFORNIA PACIFIC MEDICAL CENTER10/15/2014 2:27 PM
DetailsProgram CodeInsert  DSH10/15/2014 2:27 PM
DetailsEntity SubnameInsert  CALIFORNIA PACIFIC MEDICAL CENTER-P10/15/2014 2:27 PM
DatesParticipating Approval DateInsert   10/15/2014 2:27 PM
DetailsStateInsert  Pending10/15/2014 2:27 PM
DatesRegistration DateInsert  10/15/2014 12:00:00 AM10/15/2014 2:27 PM
DatesSigned By DateInsert  10/15/2014 12:00:00 AM10/15/2014 2:27 PM
DatesStart DateInsert   10/15/2014 2:27 PM
TerminationsTermination CommentsInsert   10/15/2014 2:27 PM
TerminationsTermination DateInsert   10/15/2014 2:27 PM
TerminationsTermination Effective DateInsert   10/15/2014 2:27 PM
TerminationsTermination ReasonInsert   10/15/2014 2:27 PM