Covered Entity Details

DSH050228F Zuckerberg San Francisco General (Active) - information as of 4/29/2025 11:56:59 PM

Main Details

Name

Zuckerberg San Francisco General

Subdivision Name

Adult Medical Center / UC Positive Health Program

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050228F

Medicare Provider Number

050228

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/15/2015

Participating Start Date

10/1/2015

Participating Approval Date

8/11/2015

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

ZSFG
Susan Ehrlich, CEO
(628) 206-8118

Primary Contact

ZSFG
David E Smith, Pharmacy Manager
(628) 206-2332

Addresses

Street Address

995 Potrero Avenue
San Francisco, CA 94110

Billing Address
Same as Street Address

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	PHB173920	1447288634,1144396979

Shipping Addresses

Shipping Address 1

San Francisco General Hospital
1001 Potrero Avenue, Room GR-1
San Francisco, CA 94110

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
DSH050228B	Child	DSH	Zuckerberg San Francisco General	ZSFG / Renal Center	1001 Potrero Avenue, Bldg 100, Rm 359	San Francisco	CA	Active
DSH050228C	Child	DSH	Zuckerberg San Francisco General	ZSFG / Urgent Care Center	995 Potrero Avenue, Ward 81	San Francisco	CA	Terminated
DSH050228D	Child	DSH	Zuckerberg San Francisco General	Family Health Center	995 Potrero Avenue	San Francisco	CA	Active
DSH050228E	Child	DSH	SAN FRANCISCO GENERAL HOSPITAL	Psychiatric Emergency Services	1001 Potrero Avenue	San Francisco	CA	Terminated
DSH050228F	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / UC Positive Health Program	995 Potrero Avenue	San Francisco	CA	Active
DSH050228G	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Chest Clinic	995 Potrero Avenue	San Francisco	CA	Active
DSH050228H	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Diabetic Clinic	995 Potrero Avenue	San Francisco	CA	Active
DSH050228J	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Cardiac Clinic	995 Potrero Avenue	San Francisco	CA	Active
DSH050228K	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Endocrine Clinic	995 Potrero Avenue	San Francisco	CA	Active
DSH050228L	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Dermatology Clinic	995 Potrero Avenue	San Francisco	CA	Active
DSH050228M	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Renal Clinic	995 Potrero Avenue	San Francisco	CA	Active
DSH050228N	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Rheumatology Clinic	995 Potrero Avenue	San Francisco	CA	Active
DSH050228P	Child	DSH	Zuckerberg San Francisco General	Psychiatric Emergency Services / ED Case Management	995 Potrero Avenue	San Francisco	CA	Active
DSH050228Q	Child	DSH	Zuckerberg San Francisco General	Adult Medical Center / Hematology/Oncology Clinic	995 Potrero Avenue	San Francisco	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 4:00:59 PM	8/12/2024 12:06:29 PM	8/12/2024 12:06 PM
Details	Last Recertification Date	Update	Recertification	8/27/2022 3:15:58 PM	8/16/2023 4:00:59 PM	8/16/2023 4:00 PM
Details	Last Recertification Date	Update	Recertification	8/26/2021 10:19:53 AM	8/27/2022 3:15:58 PM	8/27/2022 3:15 PM
Contacts	Primary Contact	Update	Change Request	Woods, David Chief Pharmacy Officer ZSFG 6282062332	Smith, David E Pharmacy Manager ZSFG 6282062332	3/31/2022 7:06 AM
Details	Last Recertification Date	Update	Recertification	8/23/2020 3:51:01 PM	8/26/2021 10:19:53 AM	8/26/2021 10:19 AM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/23/2020 3:51 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/23/2020 3:51 PM
Details	Last Recertification Date	Update	Recertification	9/8/2019 10:25:17 AM	8/23/2020 3:51:01 PM	8/23/2020 3:51 PM
Contacts	Authorizing Official	Update	Profile Change Request	Ehrlich, Susan CEO ZSFG 4152068118	Ehrlich, Susan CEO ZSFG 6282068118	9/8/2019 10:31 AM
Details	Last Recertification Date	Update	Recertification	9/7/2018 8:33:24 PM	9/8/2019 10:25:17 AM	9/8/2019 10:25 AM
Contacts	Primary Contact	Update	Profile Change Request	Woods, David Chief Pharmacy Officer ZSFG 4152062332	Woods, David Chief Pharmacy Officer ZSFG 6282062332	9/3/2019 6:30 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 9:35:39 AM	9/7/2018 8:33:24 PM	9/7/2018 8:33 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/8/2017 9:35:39 AM	11/8/2017 9:35 AM
Contacts	Authorizing Official	Update		Ehrlich, Susan CEO 4152068118	Ehrlich, Susan CEO ZSFG 4152068118	10/2/2017 1:13 PM
Contacts	Primary Contact	Update		Woods, David Chief Pharmacy Officer 4152062332	Woods, David Chief Pharmacy Officer ZSFG 4152062332	10/2/2017 12:01 PM
Contacts	Authorizing Official	Insert			Ehrlich, Susan CEO 4152068118	6/28/2017 3:13 PM
Contacts	Primary Contact	Insert			Woods, David Chief Pharmacy Officer 4152062332	6/28/2017 3:13 PM
Contacts	Signed By	Insert			Currin, Susan Chief Executive Officer 4152063517	2/13/2017 12:07 PM
Addresses	Main Address	Insert			995 Potrero Avenue San Francisco, CA 94110	1/17/2017 11:46 AM
Addresses	Shipping Address	Insert			San Francisco General Hospital 1001 Potrero Avenue, Room GR-1 San Francisco, CA 94110	1/17/2017 11:46 AM
Details	Entity Name	Update		SAN FRANCISCO GENERAL HOSPITAL	Zuckerberg San Francisco General	1/17/2017 11:45 AM
Medicaid Billing	NPI: Number	Insert			1144396979	8/18/2016 10:30 AM
Details	Last Recertification Date	Update			8/18/2016 12:00:00 AM	8/18/2016 10:30 AM
Details	Entity Subname	Update		Adult Medical Center / UC Positive Health Program (Ward 86)	Adult Medical Center / UC Positive Health Program	8/18/2016 10:30 AM
Dates	Participating Approval Date	Update			8/11/2015 12:00:00 AM	8/11/2015 9:59 AM
Details	State	Update		Pending	Active	8/11/2015 9:59 AM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	8/11/2015 9:59 AM
Details	340B ID	Update		DSH000000	DSH050228F	8/10/2015 4:20 PM
Details	340B ID	Update		DSH050039D	DSH000000	8/4/2015 2:24 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_54021	DSH050039D	8/4/2015 2:23 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_54021	7/15/2015 5:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/15/2015 5:27 PM
Medicaid Billing	Medicaid: Number	Insert			PHB173920	7/15/2015 5:27 PM
Medicaid Billing	Medicaid: State	Insert			CA	7/15/2015 5:27 PM
Medicaid Billing	NPI: Number	Insert			1447288634	7/15/2015 5:27 PM
Details	Last Recertification Date	Insert				7/15/2015 5:27 PM
Details	Grant Number	Insert				7/15/2015 5:27 PM
Details	340B ID	Insert				7/15/2015 5:27 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2015 5:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2015 5:27 PM
Details	Medicare Provider Number	Insert			050228	7/15/2015 5:27 PM
Details	Entity Name	Insert			SAN FRANCISCO GENERAL HOSPITAL	7/15/2015 5:27 PM
Details	Program Code	Insert			DSH	7/15/2015 5:27 PM
Details	Entity Subname	Insert			Adult Medical Center / UC Positive Health Program (Ward 86)	7/15/2015 5:27 PM
Dates	Participating Approval Date	Insert				7/15/2015 5:27 PM
Details	State	Insert			Pending	7/15/2015 5:27 PM
Dates	Registration Date	Insert			7/15/2015 12:00:00 AM	7/15/2015 5:27 PM
Dates	Signed By Date	Insert			7/15/2015 12:00:00 AM	7/15/2015 5:27 PM
Dates	Start Date	Insert				7/15/2015 5:27 PM
Terminations	Termination Comments	Insert				7/15/2015 5:27 PM
Terminations	Termination Date	Insert				7/15/2015 5:27 PM
Terminations	Termination Effective Date	Insert				7/15/2015 5:27 PM
Terminations	Termination Reason	Insert				7/15/2015 5:27 PM