Covered Entity Details

DSH050047Q SUTTER BAY HOSPITALS DBA (Terminated) - information as of 5/10/2025 11:04:09 PM

Main Details

Name

SUTTER BAY HOSPITALS DBA

Subdivision Name

CALIFORNIA CAMPUS / MRI

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050047Q

Medicare Provider Number

050047

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/12/2017

Participating Start Date

4/1/2017

Participating Approval Date

2/21/2017

Last Recertification Date

8/31/2018

Termination Date
Termination Reason

10/1/2019
Site closure

Contacts

Authorizing Official

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

Primary Contact

California Pacific Med Ctr
DON WILLIS, PHARMACY PURCH SYSTEMS MANAGER
(415) 600-3200

Addresses

Street Address

3700 CALIFORNIA ST G350
SAN FRANCISCO, CA 94118

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	HSP40047G
		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	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		7/17/2019 12:00:00 AM	7/22/2019 11:50 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/22/2019 11:50 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	7/22/2019 11:50 AM
Terminations	Termination Effective Date	Update	Termination Request		7/17/2019 12:00:00 AM	7/22/2019 11:50 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	7/22/2019 11:50 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 1:24:41 PM	8/31/2018 12:37:35 PM	8/31/2018 12:37 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 1:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1902964109	11/15/2017 1:24 PM
Details	Last Recertification Date	Update	Recertification		11/15/2017 1:24:41 PM	11/15/2017 1:24 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	Signed By	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	Signed By	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			3700 CALIFORNIA ST G350 SAN FRANCISCO, CA 94118	2/21/2017 2:34 PM
Dates	Participating Approval Date	Update			2/21/2017 12:00:00 AM	2/21/2017 2:33 PM
Details	State	Update		Pending	Active	2/21/2017 2:33 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	2/21/2017 2:33 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_74763	DSH050047Q	1/19/2017 9:12 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_74763	1/12/2017 6:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/12/2017 6:08 PM
Medicaid Billing	Medicaid: Number	Insert			HSP40047G	1/12/2017 6:08 PM
Medicaid Billing	Medicaid: State	Insert			CA	1/12/2017 6:08 PM
Medicaid Billing	NPI: Number	Insert			1780742981	1/12/2017 6:08 PM
Details	Last Recertification Date	Insert				1/12/2017 6:08 PM
Details	Grant Number	Insert				1/12/2017 6:08 PM
Details	340B ID	Insert				1/12/2017 6:08 PM
Details	Is Authorizing Official EHB Data	Insert				1/12/2017 6:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/12/2017 6:08 PM
Details	Medicare Provider Number	Insert			050047	1/12/2017 6:08 PM
Details	Entity Name	Insert			CALIFORNIA PACIFIC MEDICAL CENTER	1/12/2017 6:08 PM
Details	Program Code	Insert			DSH	1/12/2017 6:08 PM
Details	Entity Subname	Insert			CALIFORNIA CAMPUS / MRI	1/12/2017 6:08 PM
Dates	Participating Approval Date	Insert				1/12/2017 6:08 PM
Details	State	Insert			Pending	1/12/2017 6:08 PM
Dates	Registration Date	Insert			1/12/2017 12:00:00 AM	1/12/2017 6:08 PM
Dates	Signed By Date	Insert			1/12/2017 12:00:00 AM	1/12/2017 6:08 PM
Dates	Start Date	Insert				1/12/2017 6:08 PM
Terminations	Termination Comments	Insert				1/12/2017 6:08 PM
Terminations	Termination Date	Insert				1/12/2017 6:08 PM
Terminations	Termination Effective Date	Insert				1/12/2017 6:08 PM
Terminations	Termination Reason	Insert				1/12/2017 6:08 PM