340B Drug Pricing Program Database


DSH050254P MARSHALL HOSPITAL (Terminated) - information as of 5/10/2025 11:09:02 PM

Main Details
MARSHALL HOSPITAL
MARSHALL OB/GYN CAMERON PARK
Disproportionate Share Hospital
No
DSH050254P
050254


Additional Details
Terminated
1/5/2016
4/1/2016
3/9/2016
8/25/2023

10/1/2023
Business decision by the Covered Entity

Contacts

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

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

Addresses

3501 PALMER DRIVE, SUITE 204
Cameron Park, CA 95682

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
PA 1972503142
FL 1972503142
ID 1972503142
MD 1972503142
MA 1972503142
CO 1972503142
MT 1972503142
TX 1972503142
OR 1972503142
WY 1972503142
NY 1972503142
WA 1972503142
LA 1972503142
NM 1972503142
MI 1972503142
NV 1972503142
Shipping Addresses

Marshall Medical Center
1100 Marshall way
placerville, CA 95667
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 
DetailsStateUpdate To Be TerminatedTerminated10/1/2023 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 7/26/2020 12:00:00 AM9/14/2023 6:40 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated9/14/2023 6:40 AM
TerminationsTermination DateUpdateTermination Request 10/1/2023 12:00:00 AM9/14/2023 6:40 AM
TerminationsTermination Effective DateUpdateTermination Request 7/31/2020 12:00:00 AM9/14/2023 6:40 AM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity9/14/2023 6:40 AM
AddressesShipping AddressInsertRecertification Marshall Medical Center 1100 Marshall way placerville, CA 956678/25/2023 8:22 AM
AddressesBilling AddressUpdateRecertificationMarshall Medical Center - Accounts Payable P.O. Box # 872 Placerville, CA 95667Marshall Medical Center 1100 Marshall Way Placerville, CA 956678/25/2023 8:22 AM
AddressesShipping AddressDeleteRecertificationMarshall Medical Center - Marshall Hospital 1100 Marshall way placerville, CA 95667 8/25/2023 8:22 AM
DetailsLast Recertification DateUpdateRecertification8/24/2022 11:33:36 AM8/25/2023 8:22:45 AM8/25/2023 8:22 AM
DetailsEntity SubnameUpdateRecertificationMARSHALL CAMERON PARK / OB/GYNMARSHALL OB/GYN CAMERON PARK8/25/2023 8:22 AM
DetailsLast Recertification DateUpdateRecertification8/18/2021 3:48:56 PM8/24/2022 11:33:36 AM8/24/2022 11:33 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 5:54:42 PM8/18/2021 3:48:56 PM8/18/2021 3:48 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/21/2020 5:54 PM
DetailsLast Recertification DateUpdateRecertification9/4/2019 5:17:19 PM8/21/2020 5:54:42 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 53062627037/27/2020 8:07 AM
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 DateUpdateRecertification8/21/2018 8:05:23 PM9/4/2019 5:17:19 PM9/4/2019 5:17 PM
DetailsLast Recertification DateUpdateRecertification11/16/2017 6:42:03 PM8/21/2018 8:05:23 PM8/21/2018 8:05 PM
DetailsLast Recertification DateUpdateRecertification8/11/2016 12:00:00 AM11/16/2017 6:42:03 PM11/16/2017 6:42 PM
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   3501 PALMER DRIVE, SUITE 204 Cameron Park, CA 9568210/28/2016 6:29 PM
AddressesBilling AddressInsert  Marshall Medical Center - Accounts Payable P.O. Box # 872 Placerville, CA 9566710/28/2016 6:29 PM
AddressesShipping AddressInsert  Marshall Medical Center - Marshall Hospital 1100 Marshall way 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  3/9/2016 12:00:00 AM3/9/2016 3:46 PM
DetailsStateUpdate PendingActive3/9/2016 3:46 PM
DatesStart DateUpdate  4/1/2016 12:00:00 AM3/9/2016 3:46 PM
DetailsEntity SubnameUpdate MARSHALL OB/GYN CAMERON PARK / OB/GYNMARSHALL CAMERON PARK / OB/GYN3/9/2016 11:35 AM
Details340B IDUpdate OUTPATIENT_ONLINE_REG_56600DSH050254P2/24/2016 9:41 AM
Details340B IDUpdate  OUTPATIENT_ONLINE_REG_566001/5/2016 3:21 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/5/2016 3:21 PM
Medicaid BillingMedicaid: NumberInsert  HSP40254F1/5/2016 3:21 PM
Medicaid BillingMedicaid: StateInsert  CA1/5/2016 3:21 PM
Medicaid BillingNPI: NumberInsert  19725031421/5/2016 3:21 PM
DetailsLast Recertification DateInsert   1/5/2016 3:21 PM
DetailsGrant NumberInsert   1/5/2016 3:21 PM
Details340B IDInsert   1/5/2016 3:21 PM
DetailsIs Authorizing Official EHB DataInsert   1/5/2016 3:21 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/5/2016 3:21 PM
DetailsMedicare Provider NumberInsert  0502541/5/2016 3:21 PM
DetailsEntity NameInsert  MARSHALL HOSPITAL1/5/2016 3:21 PM
DetailsProgram CodeInsert  DSH1/5/2016 3:21 PM
DetailsEntity SubnameInsert  MARSHALL OB/GYN CAMERON PARK / OB/GYN1/5/2016 3:21 PM
DatesParticipating Approval DateInsert   1/5/2016 3:21 PM
DetailsStateInsert  Pending1/5/2016 3:21 PM
DatesRegistration DateInsert  1/5/2016 12:00:00 AM1/5/2016 3:21 PM
DatesSigned By DateInsert  1/5/2016 12:00:00 AM1/5/2016 3:21 PM
DatesStart DateInsert   1/5/2016 3:21 PM
TerminationsTermination CommentsInsert   1/5/2016 3:21 PM
TerminationsTermination DateInsert   1/5/2016 3:21 PM
TerminationsTermination Effective DateInsert   1/5/2016 3:21 PM
TerminationsTermination ReasonInsert   1/5/2016 3:21 PM