340B Drug Pricing Program Database


DSH050254 MARSHALL HOSPITAL (Active) - information as of 6/4/2025 1:15:20 PM

Main Details
MARSHALL HOSPITAL
Disproportionate Share Hospital
No
DSH050254
050254


Additional Details
Active
10/13/2015
1/1/2016
10/26/2015
8/12/2024

Contacts

Marshall Medical Center
Siri Nelson, CEO
(707) 349-8127

Marshall Medical Center
Stephanie A Godon, Director of Pharmacy
(530) 626-2703

Addresses

1100 MARSHALL WAY
PLACERVILLE, CA 95667

Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667


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

Yes
StateMedicaid NumberNPI Number
CAHSP40254F1972503142,1447912191
ID 1972503142
TX 1972503142
OR 1972503142
WA 1972503142
NM 1972503142
NV 1972503142
VA 1972503142
AR 1972503142
AZ 1972503142
Shipping Addresses

Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667

Marshall Medical Specialty Pharmacy
3581 Palmer Drive
Suite 601
Cameron Park, CA 95682

Safecor Health, LLC
4060 Business Park Drive
Columbus, OH 43204
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884901/19/201704/01/2017  01/19/2017
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750201/19/201704/01/2017 05/01/202505/27/2025
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/05/201707/01/2017  04/05/2017
Contract DetailBEL AIR PHARMACY #5153510 PALMER DRIVE
CAMERON PARKCA9568204/04/201607/01/2016 11/27/201811/27/2018
Contract DetailBEL AIR PHARMACY #5153510 PALMER DRIVE
CAMERON PARKCA9568207/12/201910/01/2019 01/09/202001/10/2020
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/07/202001/01/2021  01/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/07/202001/01/2021  01/01/2021
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/04/202101/01/2022  01/01/2022
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/04/202101/01/2022  01/01/2022
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/07/202001/01/2021  01/01/2021
Contract DetailCYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503301/12/201604/01/2016 08/09/201708/10/2017
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503306/28/201707/01/2017 02/18/202002/18/2020
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268304/13/202107/01/2021 12/12/202212/13/2022
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111210/07/202001/01/2021  01/01/2021
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313410/03/202401/01/2025  01/01/2025
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS/PHARMACY # 17787 3968 MISSOURI FLAT RD
PLACERVILLECA9566701/05/202304/01/2023 03/05/202403/27/2024
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09490 6450 PONY EXPRESS TRL
POLLOCK PINESCA9572610/11/201801/01/2019  01/01/2019
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09184 3964 MISSOURI FLAT RD STE A
PLACERVILLECA9566710/11/201801/01/2019  01/01/2019
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 06793 3020 GREEN VALLEY RD STE B
CAMERON PARKCA9568210/11/201801/01/2019  01/01/2019
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03009 3500 PALMER DR
CAMERON PARKCA9568210/11/201801/01/2019  01/01/2019
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09823 1350 FLORIN ROAD
SACRAMENTOCA9582210/15/201801/01/2019 11/27/201811/27/2018
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09814 8101 GREENBACK LANE
FAIR OAKSCA9562810/07/202001/01/2021  01/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09233 515 S STATE HIGHWAY 49
JACKSONCA9564210/07/202001/01/2021  01/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03909 4330 LATROBE RD
EL DORADO HILLSCA9576210/04/202101/01/2022  01/01/2022
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03950 2790 E BIDWELL ST
FOLSOMCA9563004/13/202307/01/2023  07/01/2023
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 11403 BLUEGRASS PARKWAY
SUITE 400 		LOUISVILLEKY40299-239801/13/201604/01/2016 12/16/202112/21/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/05/202301/25/2023 08/01/202409/23/2024
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502910/03/202401/01/2025  01/01/2025
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/03/202401/01/2025  01/01/2025
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/13/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/13/202107/01/2021 04/01/202504/07/2025
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/13/202107/01/2021 08/01/202409/23/2024
Contract DetailOPTUM PHARMACY 806, INC.2288 AUBURN BLVD STE. 102
SACRAMENTOCA95821-161804/13/202107/01/2021 07/12/202107/16/2021
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660804/13/202107/01/2021 05/27/202206/28/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/13/202107/01/2021 04/01/202504/07/2025
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/10/201710/01/2017 01/07/201901/10/2019
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/07/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/07/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/07/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/07/202001/01/2021  01/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 445 CASTRO STREET
SAN FRANCISCOCA9411410/07/202001/01/2021  01/01/2021
Contract DetailRALEY'S CENTRAL PHARMACY #9492928 RAMCO ST. SUITE 100
WEST SACRAMENTOCA9569104/04/201607/01/2016 11/27/201811/27/2018
Contract DetailRALEY'S PHARMACY #422166 PLACERVILLE DR
PLACERVILLECA9566704/04/201607/01/2016 11/27/201811/27/2018
Contract DetailRALEY'S PHARMACY #422166 PLACERVILLE DR
PLACERVILLECA9566707/12/201910/01/2019 01/09/202001/10/2020
Contract DetailRIVER CITY PHARMACY, INC.OPTION CARE 3301 C ST., STE 450
SACRAMENTOCA95816-339301/13/201604/01/2016 12/16/202112/21/2021
Contract DetailROBINSON'S PHARMACY359 MAIN ST
PLACERVILLECA95667-560501/13/201604/01/2016  10/28/2016
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1724 3955 MISSOURI FLAT ROAD
PLACERVILLECA9566710/20/201601/01/2017 02/13/202401/23/2025
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1618 3380 COACH LANE
CAMERON PARKCA9568210/20/201601/01/2017 02/13/202401/23/2025
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1825 6498 PONY EXPRESS TRAIL
POLLOCK PINESCA9572610/20/201601/01/2017 02/13/202502/13/2025
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #2683 2207 FRANCISCO DRIVE
EL DORADO HILLSCA9576210/20/201601/01/2017 02/13/202502/13/2025
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #6057 1220 BROADWAY
PLACERVILLECA9566707/21/201610/01/2016  10/28/2016
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #6058 31 FAIR LANE
PLACERVILLECA9566707/21/201610/01/2016 01/09/202403/27/2024
Contract DetailTHRIFTY PAYLESS, INC.RITE AID #6526 3101 GREEN VALLEY ROAD
CAMERON PARKCA9568207/21/201610/01/2016 04/06/202205/16/2022
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/17/201710/01/2017  10/01/2017
Contract DetailWAL-MART PHARMACY 10-24184300 MISSOURI FLAT RD
PLACERVILLECA9566701/13/201604/01/2016  10/28/2016
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283708/01/201710/01/2017  10/01/2017
Contract DetailWALGREEN CO.DBA: WALGREENS #10599 4014 PLAZA GOLDORADO CIR.
CAMERON PARKCA9568201/12/201604/01/2016 02/05/202503/12/2025
Contract DetailWALGREEN CO.DBA: WALGREENS #11823 4220 MISSOURI FLAT RD
PLACERVILLECA9566701/12/201604/01/2016 04/05/202405/13/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #12840 8230 SARATOGA WAY
EL DORADO HILLSCA9576204/10/201907/01/2019  07/01/2019
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15296 2262 MARKET ST
SAN FRANCISCOCA9411401/15/202004/01/2020 08/30/202409/23/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/12/201604/01/2016 08/30/202409/23/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/12/201604/01/2016 02/18/202002/18/2020
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/12/201604/01/2016 02/18/202002/18/2020
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/12/201604/01/2016 09/01/202309/13/2023
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275610/11/202301/01/2024  01/01/2024
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/11/202301/01/2024  01/01/2024
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050254AChildDSHMARSHALL HOSPITALMMF OP INFUSION3581 PALMER DRIVE suite 400CAMERON PARKCAActive
DSH050254AAChildDSHMARSHALL HOSPITALMARSHALL ENT - ENT4300 Golden Center Drive Suite DPlacervilleCAActive
DSH050254ABChildDSHMARSHALL HOSPITALMARSHALL ORTHOPEDICS AND SPORTS MEDICINE EL DORADO HILLS5137 GOLDEN FOOTHILL PARKWAY SUITE 120EL DORADO HILLSCAActive
DSH050254ACChildDSHMARSHALL HOSPITALMARSHALL PULMONOLOGY PLACERVILLE1004 FOWLER WAY SUITE 4PLACERVILLECAActive
DSH050254ADChildDSHMARSHALL HOSPITALMARSHALL PULMONOLOGY - CP3501 Palmer DriveCameron ParkCAActive
DSH050254AEChildDSHMARSHALL HOSPITALMARSHALL CARES - Addiction Treatment Center1045 Marshall WayPlacervilleCATerminated
DSH050254AFChildDSHMARSHALL HOSPITALMARSHALL CANCER CENTER3581 PALMER DRIVE Suite 400Cameron ParkCAActive
DSH050254AGChildDSHMARSHALL HOSPITALMMF NEUROLOGY3581 Palmer DriveCameron ParkCATerminated
DSH050254AHChildDSHMARSHALL HOSPITALDiagnostic Imaging - CT Scanner3581 Palmer DriveCameron ParkCAActive
DSH050254AJChildDSHMARSHALL HOSPITALMMF CARDIOLOGY - EDH5137 Golden Foothill ParkwayEl Dorado HillsCAActive
DSH050254AKChildDSHMARSHALL HOSPITALDiagnostic Imaging - MRI3581 Palmer DriveCameron ParkCAActive
DSH050254ALChildDSHMARSHALL HOSPITALDiagnostic Imaging3581 Palmer DriveCameron ParkCAActive
DSH050254AMChildDSHMARSHALL HOSPITALPhysical Rehab SVCS - Outpatient1000 Fowler WayPlacervilleCAActive
DSH050254ANChildDSHMARSHALL HOSPITALMARSHALL MEDICAL CENTER - RECOVERY - CAMERON PARK SURGERY CENTER3501 PALMER DR 100CAMERON PARKCAActive
DSH050254APChildDSHMARSHALL HOSPITALMARSHALL MEDICAL CENTER - DIAGNOSTIC IMAGING - ULTRASOUND CAMERON PARK3581 PALMER DR 300CAMERON PARKCAActive
DSH050254AQChildDSHMARSHALL HOSPITALMARSHALL MEDICAL CENTER - SURGERY - CAMERON PARK SURGERY CENTER3501 PALMER DR 100CAMERON PARKCAActive
DSH050254BChildDSHMARSHALL HOSPITALCardiac Services - Cardiac Rehab1000 Fowler WayPlacervilleCAActive
DSH050254CChildDSHMARSHALL HOSPITALMARSHALL OUTPATIENT SURGERY3501 PALMER DRIVE, SUITE 100CAMERON PARKCAActive
DSH050254DChildDSHMARSHALL HOSPITALDIVIDE WELLNESS CENTER6065 HIGHWAY 193GEORGETOWNCAActive
DSH050254EChildDSHMARSHALL HOSPITALMARSHALL CARDIOLOGY1004 FOWLER WAY, SUITE 4PlacervilleCAActive
DSH050254FChildDSHMARSHALL HOSPITALMARSHALL WHOLE CHILD HEALTH3106 Ponte Morino Drive, Suite BCAMERON PARKCATerminated
DSH050254GChildDSHMARSHALL HOSPITALMARSHALL EDH / FAMILY MEDICINE5137 GOLDEN FOOTHILL PKWY, #120EL DORADO HILLSCAActive
DSH050254HChildDSHMARSHALL HOSPITALMARSHALL RHEUMATOLOGY3501 PALMER DRIVE, SUITE 201Cameron ParkCAActive
DSH050254JChildDSHMARSHALL HOSPITALMARSHALL SIERRA PRIMARY MEDICINE4341-B GOLDEN CENTER DRIVEPlacervilleCAActive
DSH050254KChildDSHMARSHALL HOSPITALMARSHALL PEDIATRICS4341-A GOLDEN CENTER DRIVEPlacervilleCAActive
DSH050254LChildDSHMARSHALL HOSPITALMARSHALL ORTHOPEDICS4300 GOLDEN CENTER DRIVE, #CPlacervilleCAActive
DSH050254MChildDSHMARSHALL HOSPITALMARSHALL FAMILY MEDICINE CAMERON PARK3581 PALMER DRIVE, SUITE 602Cameron ParkCAActive
DSH050254NChildDSHMARSHALL HOSPITALMARSHALL UROLOGY3501 PALMER DRIVE, SUITE 204Cameron ParkCATerminated
DSH050254PChildDSHMARSHALL HOSPITALMARSHALL OB/GYN CAMERON PARK3501 PALMER DRIVE, SUITE 204Cameron ParkCATerminated
DSH050254QChildDSHMARSHALL HOSPITALMARSHALL WOUND CARE1095 MARSHALL WAY, SUITE 203PlacervilleCAActive
DSH050254RChildDSHMARSHALL HOSPITALMARSHALL GENERAL SURGERY1095 MARSHALL WAY, SUITE 202PlacervilleCAActive
DSH050254SChildDSHMARSHALL HOSPITALMARSHALL OB/GYN PLACERVILLE1095 MARSHALL WAY, SUITE 201PlacervilleCAActive
DSH050254TChildDSHMARSHALL HOSPITALMARSHALL FAMILY MEDICINE PLACERVILLE1095 MARSHALL WAY, SUITE 100PLACERVILLECAActive
DSH050254UChildDSHMARSHALL HOSPITALMARSHALL GASTROENTEROLOGY3501 PALMER DR STE 201CAMERON PARKCAActive
DSH050254VChildDSHMARSHALL HOSPITALMARSHALL CARDIOLOGY CAMERON PARK3501 Palmer DriveCameron ParkCAActive
DSH050254WChildDSHMARSHALL HOSPITALMARSHALL GASTROENTEROLOGY PLACERVILLE - GI PLACERVILLE1095 MARSHALL WAY SUITE 101PLACERVILLECATerminated
DSH050254XChildDSHMARSHALL HOSPITALMARSHALL UROLOGY PLACERVILLE1095 MARSHALL WAY SUITES 201 & 202PLACERVILLECAActive
DSH050254YChildDSHMARSHALL HOSPITALMARSHALL PODIATRY3501 PALMER DRIVE SUITE 201CAMERON PARKCAActive
DSH050254ZChildDSHMARSHALL HOSPITALMARSHALL PSYCHIATRY CAMERON PARK - PSYCH CP3581 PALMER DRIVE SUITE 202CAMERON PARKCATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertChange Request Safecor Health, LLC 4060 Business Park Drive Columbus, OH 432043/24/2025 8:20 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (PA) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (FL) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (MD) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (MA) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (CO) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (MT) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (WY) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (NY) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (LA) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberDeleteGroup Change Request1972503142 (MI) 11/15/2024 12:06 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 197250314211/15/2024 12:06 PM
Medicaid BillingNPI: StateInsertGroup Change Request VA11/15/2024 12:06 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 197250314211/15/2024 12:06 PM
Medicaid BillingNPI: StateInsertGroup Change Request AR11/15/2024 12:06 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 197250314211/15/2024 12:06 PM
Medicaid BillingNPI: StateInsertGroup Change Request AZ11/15/2024 12:06 PM
DetailsLast Recertification DateUpdateRecertification8/26/2023 1:20:38 PM8/12/2024 2:05:13 PM8/12/2024 2:05 PM
DetailsLast Recertification DateUpdateRecertification9/2/2022 6:59:23 AM8/26/2023 1:20:38 PM8/26/2023 1:20 PM
AddressesShipping AddressUpdateChange RequestMarshall Medical Specialty Pharmacy 3581 Palmer Drive Suite 600 Cameron Park, CA 95682Marshall Medical Specialty Pharmacy 3581 Palmer Drive Suite 601 Cameron Park, CA 9568212/14/2022 7:07 AM
Medicaid BillingNPI: NumberInsertChange Request 144791219112/14/2022 7:07 AM
Medicaid BillingNPI: StateInsertChange Request CA12/14/2022 7:07 AM
AddressesBilling AddressUpdateChange RequestMarshall Medical Center - Accounts Payable P.O. Box # 872 Placerville, CA 95667Marshall Medical Center 1100 Marshall Way Placerville, CA 956679/27/2022 1:55 PM
AddressesShipping AddressUpdateChange RequestMarshall Medical Specialty Pharmacy 3581 Palmer Drive Suite 600 Cameron Park, CA 85682Marshall Medical Specialty Pharmacy 3581 Palmer Drive Suite 600 Cameron Park, CA 956829/9/2022 9:03 AM
DetailsLast Recertification DateUpdateRecertification9/7/2021 1:56:07 PM9/2/2022 6:59:23 AM9/2/2022 6:59 AM
AddressesShipping AddressInsertChange Request Marshall Medical Center 1100 Marshall Way Placerville, CA 956678/23/2022 6:54 AM
AddressesShipping AddressInsertChange Request Marshall Medical Specialty Pharmacy 3581 Palmer Drive Suite 600 Cameron Park, CA 856828/23/2022 6:54 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request FL8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request ID8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request MD8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request MA8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request CO8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request MT8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request TX8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request OR8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request WY8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request NY8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request WA8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request LA8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request NM8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request MI8/8/2022 7:40 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 19725031428/8/2022 7:40 PM
Medicaid BillingNPI: StateInsertGroup Change Request NV8/8/2022 7:40 PM
DetailsLast Recertification DateUpdateRecertification8/21/2020 5:54:26 PM9/7/2021 1:56:07 PM9/7/2021 1:56 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/21/2020 5:54 PM
DetailsLast Recertification DateUpdateRecertification9/5/2019 7:42:32 AM8/21/2020 5:54:26 PM8/21/2020 5:54 PM
ContactsPrimary ContactUpdateChange RequestDiPonti, Bob Director of Pharmacy Marshall med Ctr 5306262657Godon, Stephanie A Director of Pharmacy Marshall Medical Center 53062627035/14/2020 2:44 PM
ContactsAuthorizing OfficialUpdateAO Change RequestWhipple, James Chief Executive Officer Marshall Medical Center 5306262601Nelson, Siri CEO Marshall Medical Center 707349812712/31/2019 7:34 AM
DetailsLast Recertification DateUpdateRecertification8/22/2018 8:41:32 AM9/5/2019 7:42:32 AM9/5/2019 7:42 AM
DetailsLast Recertification DateUpdateRecertification11/17/2017 6:51:46 AM8/22/2018 8:41:32 AM8/22/2018 8:41 AM
DetailsLast Recertification DateUpdateRecertification8/11/2016 12:00:00 AM11/17/2017 6:51:46 AM11/17/2017 6:51 AM
ContactsAuthorizing OfficialUpdate Whipple, James Chief Executive Officer 5306262601Whipple, James Chief Executive Officer Marshall Medical Center 530626260110/17/2017 2:19 PM
ContactsSigned ByUpdate Whipple, James Chief Executive Officer 5306262601Whipple, James Chief Executive Officer Marshall Medical Center 530626260110/17/2017 2:19 PM
ContactsPrimary ContactUpdate DiPonti, Bob Director of Pharmacy 5306262657DiPonti, Bob Director of Pharmacy Marshall med Ctr 53062626579/26/2017 7:53 PM
ContactsAuthorizing OfficialInsert  Whipple, James Chief Executive Officer 53062626018/10/2017 10:39 PM
ContactsSigned ByInsert  Whipple, James Chief Executive Officer 53062626018/10/2017 10:39 PM
ContactsPrimary ContactInsert  DiPonti, Bob Director of Pharmacy 530626265712/12/2016 3:34 PM
AddressesMain AddressInsert   1100 MARSHALL WAY PLACERVILLE, CA 9566710/28/2016 6:29 PM
AddressesBilling AddressInsert  Marshall Medical Center - Accounts Payable P.O. Box # 872 Placerville, CA 9566710/28/2016 6:29 PM
DetailsLast Recertification DateUpdate  8/11/2016 12:00:00 AM8/11/2016 12:08 PM
DatesParticipating Approval DateUpdate  10/26/2015 12:00:00 AM10/26/2015 12:52 PM
DetailsStateUpdate PendingActive10/26/2015 12:52 PM
DatesStart DateUpdate  1/1/2016 12:00:00 AM10/26/2015 12:52 PM
Details340B IDUpdate ONLINE_REG_55258DSH05025410/15/2015 2:17 PM
Details340B IDUpdate  ONLINE_REG_5525810/13/2015 1:10 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False10/13/2015 1:10 PM
Medicaid BillingMedicaid: NumberInsert  HSP40254F10/13/2015 1:10 PM
Medicaid BillingMedicaid: StateInsert  CA10/13/2015 1:10 PM
Medicaid BillingNPI: NumberInsert  197250314210/13/2015 1:10 PM
DetailsLast Recertification DateInsert   10/13/2015 1:10 PM
DetailsGrant NumberInsert   10/13/2015 1:10 PM
Details340B IDInsert   10/13/2015 1:10 PM
DetailsIs Authorizing Official EHB DataInsert   10/13/2015 1:10 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/13/2015 1:10 PM
DetailsMedicare Provider NumberInsert  05025410/13/2015 1:10 PM
DetailsEntity NameInsert  MARSHALL HOSPITAL10/13/2015 1:10 PM
DetailsProgram CodeInsert  DSH10/13/2015 1:10 PM
DetailsEntity SubnameInsert   10/13/2015 1:10 PM
DatesParticipating Approval DateInsert   10/13/2015 1:10 PM
DetailsStateInsert  Pending10/13/2015 1:10 PM
DatesRegistration DateInsert  10/13/2015 12:00:00 AM10/13/2015 1:10 PM
DatesSigned By DateInsert  10/13/2015 12:00:00 AM10/13/2015 1:10 PM
DatesStart DateInsert   10/13/2015 1:10 PM
TerminationsTermination CommentsInsert   10/13/2015 1:10 PM
TerminationsTermination DateInsert   10/13/2015 1:10 PM
TerminationsTermination Effective DateInsert   10/13/2015 1:10 PM
TerminationsTermination ReasonInsert   10/13/2015 1:10 PM