340B Drug Pricing Program Database


DSH050254W MARSHALL HOSPITAL (Terminated) - information as of 4/25/2025 5:40:48 PM

Main Details
MARSHALL HOSPITAL
MARSHALL GASTROENTEROLOGY PLACERVILLE - GI PLACERVILLE
Disproportionate Share Hospital
No
DSH050254W
050254


Additional Details
Terminated
10/11/2018
1/1/2019
10/17/2018
8/25/2022

7/1/2023
Other

Contacts

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

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

Addresses

1095 MARSHALL WAY SUITE 101
PLACERVILLE, CA 95667

Marshall Medical Center - Accounts Payable
P.O. Box # 872
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 - Marshall Hospital
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 TerminatedTerminated7/1/2023 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 5/3/2023 12:00:00 AM5/5/2023 7:12 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated5/5/2023 7:12 AM
TerminationsTermination CommentsUpdateTermination Request Never opened as a physical clinic that see's patients 5/5/2023 7:12 AM
TerminationsTermination DateUpdateTermination Request 7/1/2023 12:00:00 AM5/5/2023 7:12 AM
TerminationsTermination Effective DateUpdateTermination Request 5/3/2023 12:00:00 AM5/5/2023 7:12 AM
TerminationsTermination ReasonUpdateTermination Request Other5/5/2023 7:12 AM
DetailsLast Recertification DateUpdateRecertification8/18/2021 3:50:19 PM8/25/2022 2:28:24 PM8/25/2022 2:28 PM
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 5:57:30 PM8/18/2021 3:50:19 PM8/18/2021 3:50 PM
Medicaid BillingNPI: StateUpdateRecertification CA8/21/2020 5:57 PM
DetailsLast Recertification DateUpdateRecertification9/4/2019 5:23:07 PM8/21/2020 5:57:30 PM8/21/2020 5:57 PM
ContactsPrimary ContactUpdateChange RequestDiPonti, Bob Director of Pharmacy Marshall med Ctr 5306262657Godon, Stephanie A Director of Pharmacy Marshall Medical Center 53062627037/27/2020 8:06 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 DateUpdateRecertification 9/4/2019 5:23:07 PM9/4/2019 5:23 PM
DetailsStateUpdate ApprovedActive1/1/2019 12:05 AM
ContactsSigned ByInsertNew Registration Whipple, James Chief Executive Officer Marshall Medical Center 530626260110/17/2018 2:07 PM
Details340B IDUpdateNew Registration DSH050254W10/17/2018 2:07 PM
DetailsEntity SubnameUpdateNew RegistrationMARSHALL GASTROENTEROLOGY PLACERVILLEMARSHALL GASTROENTEROLOGY PLACERVILLE - GI PLACERVILLE10/17/2018 2:07 PM
DatesParticipating Approval DateUpdateNew Registration 10/17/2018 2:07:19 PM10/17/2018 2:07 PM
DetailsStateUpdateNew RegistrationPendingApproved10/17/2018 2:07 PM
DatesSigned By DateUpdateNew Registration 10/12/2018 2:25:12 PM10/17/2018 2:07 PM
DatesStart DateUpdateNew Registration 1/1/2019 12:00:00 AM10/17/2018 2:07 PM
AddressesMain AddressInsertNew Registration  1095 MARSHALL WAY SUITE 101 PLACERVILLE, CA 9566710/11/2018 6:52 PM
AddressesBilling AddressInsertNew Registration Marshall Medical Center - Accounts Payable P.O. Box # 872 Placerville, CA 9566710/11/2018 6:52 PM
AddressesShipping AddressInsertNew Registration Marshall Medical Center - Marshall Hospital 1100 Marshall Way Placerville, CA 9566710/11/2018 6:52 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False10/11/2018 6:52 PM
Medicaid BillingMedicaid: NumberInsertNew Registration HSP40254F10/11/2018 6:52 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA10/11/2018 6:52 PM
Medicaid BillingNPI: NumberInsertNew Registration 197250314210/11/2018 6:52 PM
ContactsAuthorizing OfficialInsertNew Registration Whipple, James Chief Executive Officer Marshall Medical Center 530626260110/11/2018 6:52 PM
ContactsPrimary ContactInsertNew Registration DiPonti, Bob Director of Pharmacy Marshall med Ctr 530626265710/11/2018 6:52 PM
DetailsLast Recertification DateInsertNew Registration  10/11/2018 6:52 PM
DetailsGrant NumberInsertNew Registration  10/11/2018 6:52 PM
Details340B IDInsertNew Registration  10/11/2018 6:52 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/11/2018 6:52 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/11/2018 6:52 PM
DetailsMedicare Provider NumberInsertNew Registration 05025410/11/2018 6:52 PM
DetailsEntity NameInsertNew Registration MARSHALL HOSPITAL10/11/2018 6:52 PM
DetailsProgram CodeInsertNew Registration DSH10/11/2018 6:52 PM
DetailsEntity SubnameInsertNew Registration MARSHALL GASTROENTEROLOGY PLACERVILLE10/11/2018 6:52 PM
DatesParticipating Approval DateInsertNew Registration  10/11/2018 6:52 PM
DetailsStateInsertNew Registration Pending10/11/2018 6:52 PM
DatesRegistration DateInsertNew Registration 10/11/2018 6:52:56 PM10/11/2018 6:52 PM
DatesSigned By DateInsertNew Registration  10/11/2018 6:52 PM
DatesStart DateInsertNew Registration  10/11/2018 6:52 PM
TerminationsTermination CommentsInsertNew Registration  10/11/2018 6:52 PM
TerminationsTermination DateInsertNew Registration  10/11/2018 6:52 PM
TerminationsTermination Effective DateInsertNew Registration  10/11/2018 6:52 PM
TerminationsTermination ReasonInsertNew Registration  10/11/2018 6:52 PM