340B Drug Pricing Program Database


DSH050047AE SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS (Active) - information as of 5/2/2025 10:40:52 PM

Main Details
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
CPMC Imaging Services - MRI
Disproportionate Share Hospital
No
DSH050047AE
050047


Additional Details
Active
10/7/2021
1/1/2022
10/12/2021
8/12/2024

Contacts

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

Sutter Health
Rachel L Dunbar, 340B Analyst
(916) 952-3480

Addresses

1100 Van Ness Avenue
2nd Floor
Rooms 2547, 2550
San Francisco, CA 94109-6919

Sutter Health
PO Box 619110
Roseville, CA 95661


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

Yes
StateMedicaid NumberNPI Number
CAHSP40047G1740348929,1780742981,1902964109
AL 1740348929,1780742981,1902964109
AK 1740348929,1780742981,1902964109
AZ 1740348929,1780742981,1902964109
CT 1740348929,1780742981,1902964109
DE 1740348929,1780742981,1902964109
DC 1740348929,1780742981,1902964109
FL 1740348929,1780742981,1902964109
GA 1740348929,1780742981,1902964109
HI 1740348929,1780742981,1902964109
KS 1740348929,1780742981,1902964109
ME 1740348929,1780742981,1902964109
MD 1740348929,1780742981,1902964109
MA 1740348929,1780742981,1902964109
MI 1740348929,1780742981,1902964109
MO 1740348929,1780742981,1902964109
MT 1740348929,1780742981,1902964109
NE 1740348929,1780742981,1902964109
NV 1740348929,1780742981,1902964109
NH 1740348929,1780742981,1902964109
NJ 1740348929,1780742981,1902964109
NM 1740348929,1780742981,1902964109
OH 1740348929,1780742981,1902964109
OK 1740348929,1780742981,1902964109
PA 1740348929,1780742981,1902964109
RI 1740348929,1780742981,1902964109
SC 1740348929,1780742981,1902964109
SD 1740348929,1780742981,1902964109
TX 1740348929,1780742981,1902964109
VT 1740348929,1780742981,1902964109
WA 1740348929,1780742981,1902964109
WY 1740348929,1780742981,1902964109
AR 1740348929,1780742981,1902964109
CO 1740348929,1780742981,1902964109
ID 1740348929,1780742981,1902964109
IL 1740348929,1780742981,1902964109
IA 1740348929,1780742981,1902964109
KY 1740348929,1780742981,1902964109
LA 1740348929,1780742981,1902964109
MN 1740348929,1780742981,1902964109
MS 1740348929,1780742981,1902964109
NC 1740348929,1780742981,1902964109
ND 1740348929,1780742981,1902964109
NY 1740348929,1780742981,1902964109
OR 1740348929,1780742981,1902964109
TN 1740348929,1780742981,1902964109
UT 1740348929,1780742981,1902964109
VA 1740348929,1780742981,1902964109
WV 1740348929,1780742981,1902964109
WI 1740348929,1780742981,1902964109
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050047AChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA PACIFIC MEDICAL CENTER CALIFORNIA CAMPUS3700 CALIFORNIA STREETSAN FRANCISCOCATerminated
DSH050047AAChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSOPERATING ROOM - RECOVERY ROOM2333 BUCHANAN STSAN FRANCISCOCATerminated
DSH050047ABChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSELECTROCARDIOLOGY - NON-INVASIVE CARDIO-EKG2333 BUCHANAN STSAN FRANCISCOCATerminated
DSH050047ACChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - CT1100 Van Ness AvenueSan FranciscoCAActive
DSH050047ADChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - X-Ray1100 Van Ness AvenueSan FranciscoCAActive
DSH050047AEChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - MRI1100 Van Ness AvenueSan FranciscoCAActive
DSH050047AFChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Imaging Services - Ultrasound1100 Van Ness AvenueSan FranciscoCAActive
DSH050047AGChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER - B.H. CANCER CARE CENTER-BUCHANAN ST2333 BUCHANAN STREETSan FranciscoCAActive
DSH050047BChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / TRANSPLANT CLINIC1100 VAN NESS AVESAN FRANCISCOCAActive
DSH050047CChildDSHSUTTER BAY HOSPITALS DBAPACIFIC CAMPUS / MRI2351 CLAY ST 100SAN FRANCISCOCATerminated
DSH050047DChildDSHCALIFORNIA PACIFIC MEDICAL CENTERCALIFORNIA PACIFIC MEDICAL CENTER-P / hEART INSTITUTE (CARDIO THORACIC)2340 CLAY ST STE 114A RMS 111 112 114SAN FRANCISCOCATerminated
DSH050047EChildDSHCALIFORNIA PACIFIC MEDICAL CENTERCALIFORNIA PACIFIC MEDICAL CENTER-P / OPHTHOMOLOGY CLINIC2340 CLAY ST FL 5 STE A RMS 503-505 507 512SAN FRANCISCOCATerminated
DSH050047FChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab,RT2351 CLAY STSAN FRANCISCOCATerminated
DSH050047GChildDSHCALIFORNIA PACIFIC MEDICAL CENTERCALIFORNIA PACIFIC MEDICAL CENTER-P / MRI2351 CLAY ST 100SAN FRANCISCOCATerminated
DSH050047HChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / Ambulatory Care2351 CLAY ST FL 6SAN FRANCISCOCATerminated
DSH050047JChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA PACIFIC MEDICAL CENTER-P / B.H. Cancer Care Center2351 CLAY ST 134SAN FRANCISCOCAActive
DSH050047KChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS WEST / OB TRIAGE3700 CALIFORNIA ST G LEVELSAN FRANCISCOCATerminated
DSH050047LChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA WEST CAMPUS / EMERGENCY DEPARTMENT3700 CALIFORNIA ST G LEVELSAN FRANCISCOCATerminated
DSH050047MChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / SURGERY3700 CALIFORNIA ST FLOOR 3SAN FRANCISCOCATerminated
DSH050047NChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / PACU (RECOVERY ROOM)3700 CALIFORNIA ST FLOOR 3SAN FRANCISCOCATerminated
DSH050047PChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / ANESTHESIA3700 CALIFORNIA ST FLOOR 3SAN FRANCISCOCATerminated
DSH050047QChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / MRI3700 CALIFORNIA ST G350SAN FRANCISCOCATerminated
DSH050047RChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / RESPIRATORY THERAPY3700 CALIFORNIA ST 3FL 375-376SAN FRANCISCOCATerminated
DSH050047SChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / GI LAB3700 CALIFORNIA ST- FLOOR 3SAN FRANCISCOCATerminated
DSH050047TChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCALIFORNIA WEST CAMPUS -RADIOLOGY3700 CALIFORNIA STSAN FRANCISCOCATerminated
DSH050047UChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSCPMC Center for Women's Health Care2333 Buchanan StreetSAN FRANCISCOCAActive
DSH050047VChildDSHSUTTER BAY HOSPITALS DBACALIFORNIA CAMPUS / Ambulatory Surgery Unit3700 CALIFORNIA ST- FLOOR 3SAN FRANCISCOCATerminated
DSH050047WChildDSHSUTTER BAY HOSPITALS DBAPacific Campus / Interventional Endoscopy Unit2351 Clay St Fl 6 Suite 600San FranciscoCATerminated
DSH050047XChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSRADIOLOGY - DIAGNOSTIC - RADIATION ONCOLOGY2333 BUCHANAN STSAN FRANCISCOCAActive
DSH050047YChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSOPERATING ROOM - ANESTHESIOLOGY2333 BUCHANAN STSAN FRANCISCOCATerminated
DSH050047ZChildDSHSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUSOPERATING ROOM - SURGERY2333 BUCHANAN STSAN FRANCISCOCATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/3/2024 8:06 PM
Medicaid BillingMedicaid: NumberInsertChange Request HSP40047G12/3/2024 8:06 PM
Medicaid BillingMedicaid: StateInsertChange Request CA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request AR12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request AR12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request AR12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request CO12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request CO12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request CO12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request ID12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request ID12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request ID12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request IL12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request IL12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request IL12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request IA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request IA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request IA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request KY12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request KY12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request KY12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request LA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request LA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request LA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request MN12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request MN12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request MN12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request MS12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request MS12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request MS12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request NC12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request NC12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request NC12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request ND12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request ND12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request ND12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request NY12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request NY12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request NY12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request OR12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request OR12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request OR12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request TN12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request TN12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request TN12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request UT12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request UT12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request UT12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request VA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request VA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request VA12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request WV12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request WV12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request WV12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 174034892912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request WI12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 178074298112/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request WI12/3/2024 8:06 PM
Medicaid BillingNPI: NumberInsertChange Request 190296410912/3/2024 8:06 PM
Medicaid BillingNPI: StateInsertChange Request WI12/3/2024 8:06 PM
ContactsPrimary ContactUpdateGroup Change RequestMinger, Patricia 340b Analyst Sutter Health 5103169771Dunbar, Rachel L 340B Analyst Sutter Health 916952348010/29/2024 7:12 AM
DetailsLast Recertification DateUpdateRecertification8/22/2023 2:47:22 PM8/12/2024 6:37:23 PM8/12/2024 6:37 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17403489291/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17807429811/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/25/2024 11:23 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19029641091/25/2024 11:23 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/25/2024 11:23 AM
ContactsPrimary ContactUpdateChange RequestMinger, Patricia Pharmacy Technician Analyst Sutter Health 4156003202Minger, Patricia 340b Analyst Sutter Health 51031697719/19/2023 11:22 AM
DetailsLast Recertification DateUpdateRecertification8/26/2022 10:55:18 AM8/22/2023 2:47:22 PM8/22/2023 2:47 PM
DetailsLast Recertification DateUpdateRecertification 8/26/2022 10:55:18 AM8/26/2022 10:55 AM
ContactsPrimary ContactUpdateProfile Change RequestMinger, Patricia Pharmacy Technician Analyst Sutter Health 5106820302Minger, Patricia Pharmacy Technician Analyst Sutter Health 41560032023/31/2022 12:49 PM
ContactsPrimary ContactUpdateGroup Change RequestYu, Collin Pharmacy Manager Sutter Health California Pacific Medical Center 4156028619Minger, Patricia Pharmacy Technician Analyst Sutter Health 51068203023/29/2022 6:48 AM
DetailsStateUpdate ApprovedActive1/1/2022 12:01 AM
ContactsSigned ByInsertNew Registration YU, HENRY VP AND CFO California Pacific Medical Center 415600385010/12/2021 1:47 PM
Details340B IDUpdateNew Registration DSH050047AE10/12/2021 1:47 PM
DetailsEntity NameUpdateNew RegistrationCALIFORNIA PACIFIC MEDICAL CENTERSUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS10/12/2021 1:47 PM
DetailsEntity SubnameUpdateNew RegistrationCPMC Imaging ServicesCPMC Imaging Services - MRI10/12/2021 1:47 PM
DatesParticipating Approval DateUpdateNew Registration 10/12/2021 1:47:28 PM10/12/2021 1:47 PM
DetailsStateUpdateNew RegistrationPendingApproved10/12/2021 1:47 PM
DatesSigned By DateUpdateNew Registration 10/11/2021 5:14:26 PM10/12/2021 1:47 PM
DatesStart DateUpdateNew Registration 1/1/2022 12:00:00 AM10/12/2021 1:47 PM
AddressesMain AddressInsertNew Registration  1100 Van Ness Avenue 2nd Floor Rooms 2547, 2550 San Francisco, CA 94109-691910/7/2021 1:53 PM
AddressesBilling AddressInsertNew Registration Sutter Health PO Box 619110 Roseville, CA 9566110/7/2021 1:53 PM
Medicaid BillingNPI: NumberInsertNew Registration 174034892910/7/2021 1:53 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/7/2021 1:53 PM
Medicaid BillingNPI: NumberInsertNew Registration 178074298110/7/2021 1:53 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/7/2021 1:53 PM
Medicaid BillingNPI: NumberInsertNew Registration 190296410910/7/2021 1:53 PM
Medicaid BillingNPI: StateInsertNew Registration CA10/7/2021 1:53 PM
ContactsAuthorizing OfficialInsertNew Registration YU, HENRY VP AND CFO California Pacific Medical Center 415600385010/7/2021 1:53 PM
ContactsPrimary ContactInsertNew Registration Yu, Collin Pharmacy Manager Sutter Health California Pacific Medical Center 415602861910/7/2021 1:53 PM
DetailsAssistance Received From DateInsertNew Registration  10/7/2021 1:53 PM
DetailsAssistance Received To DateInsertNew Registration  10/7/2021 1:53 PM
DetailsLast Recertification DateInsertNew Registration  10/7/2021 1:53 PM
DetailsGrant NumberInsertNew Registration  10/7/2021 1:53 PM
Details340B IDInsertNew Registration  10/7/2021 1:53 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/7/2021 1:53 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/7/2021 1:53 PM
DetailsMedicare Provider NumberInsertNew Registration 05004710/7/2021 1:53 PM
DetailsEntity NameInsertNew Registration CALIFORNIA PACIFIC MEDICAL CENTER10/7/2021 1:53 PM
DetailsNOFO NumberInsertNew Registration  10/7/2021 1:53 PM
DetailsProgram CodeInsertNew Registration DSH10/7/2021 1:53 PM
DetailsEntity SubnameInsertNew Registration CPMC Imaging Services10/7/2021 1:53 PM
DatesParticipating Approval DateInsertNew Registration  10/7/2021 1:53 PM
DetailsStateInsertNew Registration Pending10/7/2021 1:53 PM
DatesRegistration DateInsertNew Registration 10/7/2021 1:53:41 PM10/7/2021 1:53 PM
DatesSigned By DateInsertNew Registration  10/7/2021 1:53 PM
DatesStart DateInsertNew Registration  10/7/2021 1:53 PM
TerminationsTermination CommentsInsertNew Registration  10/7/2021 1:53 PM
TerminationsTermination DateInsertNew Registration  10/7/2021 1:53 PM
TerminationsTermination Effective DateInsertNew Registration  10/7/2021 1:53 PM
TerminationsTermination ReasonInsertNew Registration  10/7/2021 1:53 PM