Covered Entity Details

DSH050047F SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS (Terminated) - information as of 5/4/2025 10:28:04 PM

Main Details

Name

SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS

Subdivision Name

CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab,RT

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050047F

Medicare Provider Number

050047

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/15/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/4/2014

Last Recertification Date

9/11/2020

Termination Date
Termination Reason

10/1/2021
Other

Contacts

Authorizing Official

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

Primary Contact

California Pacific Medical Center
Paul Knaus, Pharmacy IS Manager
(415) 600-3142

Addresses

Street Address

2351 CLAY ST
502-506
SAN FRANCISCO, CA 94115-1931

Billing Address

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

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
CA	9500047	1780742981,1740348929,1902964109

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH050047A	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA PACIFIC MEDICAL CENTER CALIFORNIA CAMPUS	3700 CALIFORNIA STREET	SAN FRANCISCO	CA	Terminated
DSH050047AA	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	OPERATING ROOM - RECOVERY ROOM	2333 BUCHANAN ST	SAN FRANCISCO	CA	Terminated
DSH050047AB	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	ELECTROCARDIOLOGY - NON-INVASIVE CARDIO-EKG	2333 BUCHANAN ST	SAN FRANCISCO	CA	Terminated
DSH050047AC	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CPMC Imaging Services - CT	1100 Van Ness Avenue	San Francisco	CA	Active
DSH050047AD	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CPMC Imaging Services - X-Ray	1100 Van Ness Avenue	San Francisco	CA	Active
DSH050047AE	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CPMC Imaging Services - MRI	1100 Van Ness Avenue	San Francisco	CA	Active
DSH050047AF	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CPMC Imaging Services - Ultrasound	1100 Van Ness Avenue	San Francisco	CA	Active
DSH050047AG	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CALIFORNIA PACIFIC MEDICAL CENTER - B.H. CANCER CARE CENTER-BUCHANAN ST	2333 BUCHANAN STREET	San Francisco	CA	Active
DSH050047B	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CALIFORNIA PACIFIC MEDICAL CENTER-P / TRANSPLANT CLINIC	1100 VAN NESS AVE	SAN FRANCISCO	CA	Active
DSH050047C	Child	DSH	SUTTER BAY HOSPITALS DBA	PACIFIC CAMPUS / MRI	2351 CLAY ST 100	SAN FRANCISCO	CA	Terminated
DSH050047D	Child	DSH	CALIFORNIA PACIFIC MEDICAL CENTER	CALIFORNIA PACIFIC MEDICAL CENTER-P / hEART INSTITUTE (CARDIO THORACIC)	2340 CLAY ST STE 114A RMS 111 112 114	SAN FRANCISCO	CA	Terminated
DSH050047E	Child	DSH	CALIFORNIA PACIFIC MEDICAL CENTER	CALIFORNIA PACIFIC MEDICAL CENTER-P / OPHTHOMOLOGY CLINIC	2340 CLAY ST FL 5 STE A RMS 503-505 507 512	SAN FRANCISCO	CA	Terminated
DSH050047F	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab,RT	2351 CLAY ST	SAN FRANCISCO	CA	Terminated
DSH050047G	Child	DSH	CALIFORNIA PACIFIC MEDICAL CENTER	CALIFORNIA PACIFIC MEDICAL CENTER-P / MRI	2351 CLAY ST 100	SAN FRANCISCO	CA	Terminated
DSH050047H	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Care	2351 CLAY ST FL 6	SAN FRANCISCO	CA	Terminated
DSH050047J	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CALIFORNIA PACIFIC MEDICAL CENTER-P / B.H. Cancer Care Center	2351 CLAY ST 134	SAN FRANCISCO	CA	Active
DSH050047K	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS WEST / OB TRIAGE	3700 CALIFORNIA ST G LEVEL	SAN FRANCISCO	CA	Terminated
DSH050047L	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA WEST CAMPUS / EMERGENCY DEPARTMENT	3700 CALIFORNIA ST G LEVEL	SAN FRANCISCO	CA	Terminated
DSH050047M	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS / SURGERY	3700 CALIFORNIA ST FLOOR 3	SAN FRANCISCO	CA	Terminated
DSH050047N	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS / PACU (RECOVERY ROOM)	3700 CALIFORNIA ST FLOOR 3	SAN FRANCISCO	CA	Terminated
DSH050047P	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS / ANESTHESIA	3700 CALIFORNIA ST FLOOR 3	SAN FRANCISCO	CA	Terminated
DSH050047Q	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS / MRI	3700 CALIFORNIA ST G350	SAN FRANCISCO	CA	Terminated
DSH050047R	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS / RESPIRATORY THERAPY	3700 CALIFORNIA ST 3FL 375-376	SAN FRANCISCO	CA	Terminated
DSH050047S	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS / GI LAB	3700 CALIFORNIA ST- FLOOR 3	SAN FRANCISCO	CA	Terminated
DSH050047T	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CALIFORNIA WEST CAMPUS -RADIOLOGY	3700 CALIFORNIA ST	SAN FRANCISCO	CA	Terminated
DSH050047U	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	CPMC Center for Women's Health Care	2333 Buchanan Street	SAN FRANCISCO	CA	Active
DSH050047V	Child	DSH	SUTTER BAY HOSPITALS DBA	CALIFORNIA CAMPUS / Ambulatory Surgery Unit	3700 CALIFORNIA ST- FLOOR 3	SAN FRANCISCO	CA	Terminated
DSH050047W	Child	DSH	SUTTER BAY HOSPITALS DBA	Pacific Campus / Interventional Endoscopy Unit	2351 Clay St Fl 6 Suite 600	San Francisco	CA	Terminated
DSH050047X	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	RADIOLOGY - DIAGNOSTIC - RADIATION ONCOLOGY	2333 BUCHANAN ST	SAN FRANCISCO	CA	Active
DSH050047Y	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	OPERATING ROOM - ANESTHESIOLOGY	2333 BUCHANAN ST	SAN FRANCISCO	CA	Terminated
DSH050047Z	Child	DSH	SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS	OPERATING ROOM - SURGERY	2333 BUCHANAN ST	SAN FRANCISCO	CA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/1/2021 12:00:00 AM	7/16/2021 1:18 PM
Details	State	Update	Termination Request	Active	To Be Terminated	7/16/2021 1:18 PM
Terminations	Termination Comments	Update	Termination Request		Clinic moved	7/16/2021 1:18 PM
Terminations	Termination Date	Update	Termination Request		10/1/2021 12:00:00 AM	7/16/2021 1:18 PM
Terminations	Termination Effective Date	Update	Termination Request		7/1/2021 12:00:00 AM	7/16/2021 1:18 PM
Terminations	Termination Reason	Update	Termination Request		Other	7/16/2021 1:18 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	9/11/2020 1:44 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	9/11/2020 1:44 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	9/11/2020 1:44 PM
Contacts	Primary Contact	Update	Recertification	WILLIS, DON PHARMACY PURCH SYSTEMS MANAGER California Pacific Med Ctr 4156003200	Knaus, Paul Pharmacy IS Manager California Pacific Medical Center 4156003142	9/11/2020 1:44 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 1:43:02 PM	9/11/2020 1:44:16 PM	9/11/2020 1:44 PM
Addresses	Billing Address	Insert	Recertification		Sutter Shared Services Accounts Payable PO Box 619110 Roseville, CA 95661	8/28/2019 1:43 PM
Details	Last Recertification Date	Update	Recertification	8/31/2018 12:33:15 PM	8/28/2019 1:43:02 PM	8/28/2019 1:43 PM
Addresses	Main Address	Update	Change Request	2351 CLAY ST 505,506 SAN FRANCISCO, CA 94115-1931	2351 CLAY ST 502-506 SAN FRANCISCO, CA 94115-1931	9/12/2018 3:23 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 1:21:24 PM	8/31/2018 12:33:15 PM	8/31/2018 12:33 PM
Contacts	Signed By	Update		GATES, JOHN CFO 4156003932	GATES, JOHN CFO Sutter Health 4156003932	11/17/2017 1:11 PM
Details	Entity Name	Update	Recertification	CALIFORNIA PACIFIC MEDICAL CENTER	SUTTER BAY HOSPITALS DBA	11/15/2017 3:20 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1740348929	11/15/2017 1:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902964109	11/15/2017 1:21 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/15/2017 1:21:24 PM	11/15/2017 1:21 PM
Contacts	Authorizing Official	Update		YU, HENRY VP AND CFO 4156003850	YU, HENRY VP AND CFO California Pacific Medical Center 4156003850	9/20/2017 11:35 AM
Contacts	Primary Contact	Update		WILLIS, DON PHARMACY PURCH SYSTEMS MANAGER 4156003200	WILLIS, DON PHARMACY PURCH SYSTEMS MANAGER California Pacific Med Ctr 4156003200	9/19/2017 4:59 PM
Contacts	Authorizing Official	Insert			YU, HENRY VP AND CFO 4156003850	8/9/2017 1:39 PM
Contacts	Primary Contact	Insert			WILLIS, DON PHARMACY PURCH SYSTEMS MANAGER 4156003200	2/21/2017 2:34 PM
Addresses	Main Address	Insert			2351 CLAY ST 505,506 SAN FRANCISCO, CA 94115-1931	2/21/2017 2:34 PM
Contacts	Signed By	Insert			GATES, JOHN CFO 4156003932	2/21/2017 2:34 PM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 3:06 PM
Medicaid Billing	NPI: Number	Insert			1780742981	6/24/2016 2:58 AM
Details	Entity Subname	Update		CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab	CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab,RT	1/15/2016 2:54 PM
Details	Last Recertification Date	Update			8/6/2015 12:00:00 AM	8/6/2015 8:14 AM
Details	Entity Subname	Update		CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab / Pulmonary Function Lab	CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab	12/12/2014 11:21 AM
Details	Entity Subname	Update		CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab	CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab / Pulmonary Function Lab	12/4/2014 5:08 PM
Dates	Participating Approval Date	Update			12/4/2014 12:00:00 AM	12/4/2014 5:08 PM
Details	State	Update		Pending	Active	12/4/2014 5:08 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/4/2014 5:08 PM
Details	Entity Subname	Update		CALIFORNIA PACIFIC MEDICAL CENTER-P	CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab	10/30/2014 3:49 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47543	DSH050047F	10/30/2014 3:49 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47543	10/15/2014 2:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/15/2014 2:50 PM
Medicaid Billing	Medicaid: Number	Insert			9500047	10/15/2014 2:50 PM
Medicaid Billing	Medicaid: State	Insert			CA	10/15/2014 2:50 PM
Details	Last Recertification Date	Insert				10/15/2014 2:50 PM
Details	Grant Number	Insert				10/15/2014 2:50 PM
Details	340B ID	Insert				10/15/2014 2:50 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2014 2:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2014 2:50 PM
Details	Medicare Provider Number	Insert			050047	10/15/2014 2:50 PM
Details	Entity Name	Insert			CALIFORNIA PACIFIC MEDICAL CENTER	10/15/2014 2:50 PM
Details	Program Code	Insert			DSH	10/15/2014 2:50 PM
Details	Entity Subname	Insert			CALIFORNIA PACIFIC MEDICAL CENTER-P	10/15/2014 2:50 PM
Dates	Participating Approval Date	Insert				10/15/2014 2:50 PM
Details	State	Insert			Pending	10/15/2014 2:50 PM
Dates	Registration Date	Insert			10/15/2014 12:00:00 AM	10/15/2014 2:50 PM
Dates	Signed By Date	Insert			10/15/2014 12:00:00 AM	10/15/2014 2:50 PM
Dates	Start Date	Insert				10/15/2014 2:50 PM
Terminations	Termination Comments	Insert				10/15/2014 2:50 PM
Terminations	Termination Date	Insert				10/15/2014 2:50 PM
Terminations	Termination Effective Date	Insert				10/15/2014 2:50 PM
Terminations	Termination Reason	Insert				10/15/2014 2:50 PM