340B Drug Pricing Program Database


DSH050254AG MARSHALL HOSPITAL (Terminated) - information as of 6/17/2025 11:43:34 PM

Main Details
MARSHALL HOSPITAL
MMF NEUROLOGY
Disproportionate Share Hospital
No
DSH050254AG
050254


Additional Details
Terminated
1/7/2022
4/1/2022
2/25/2022
8/28/2023

10/1/2023
Site closure

Contacts

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

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

Addresses

3581 Palmer Drive
202
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
CAHSP402541972503142
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 3/1/2023 12:00:00 AM9/14/2023 6:40 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated9/14/2023 6:40 AM
TerminationsTermination CommentsUpdateTermination Request This child site never purchased medications, Site closed 4/18/23.9/14/2023 6:40 AM
TerminationsTermination DateUpdateTermination Request 10/1/2023 12:00:00 AM9/14/2023 6:40 AM
TerminationsTermination Effective DateUpdateTermination Request 4/18/2023 12:00:00 AM9/14/2023 6:40 AM
TerminationsTermination ReasonUpdateTermination Request Site closure9/14/2023 6:40 AM
AddressesBilling AddressUpdateRecertificationMarshall Medical Center P.O. Box 872 Placerville, CA 95667Marshall Medical Center 1100 Marshall Way Placerville, CA 956678/28/2023 2:25 PM
DetailsLast Recertification DateUpdateRecertification8/25/2022 1:52:03 PM8/28/2023 2:25:02 PM8/28/2023 2:25 PM
DetailsEntity SubnameUpdateRecertificationMMF Neurology - NeurologyMMF NEUROLOGY8/28/2023 2:25 PM
DetailsLast Recertification DateUpdateRecertification 8/25/2022 1:52:03 PM8/25/2022 1:52 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
AddressesShipping AddressInsertChange Request Marshall Medical Center 1100 Marshall Way Placerville, CA 956677/12/2022 8:40 AM
DetailsStateUpdate ApprovedActive4/1/2022 12:01 AM
ContactsSigned ByInsertNew Registration Nelson, Siri CEO Marshall Medical Center 70734981272/25/2022 12:40 PM
Details340B IDUpdateNew Registration DSH050254AG2/25/2022 12:40 PM
DetailsEntity SubnameUpdateNew RegistrationMMF NeurologyMMF Neurology - Neurology2/25/2022 12:40 PM
DatesParticipating Approval DateUpdateNew Registration 2/25/2022 12:40:17 PM2/25/2022 12:40 PM
DetailsStateUpdateNew RegistrationPendingApproved2/25/2022 12:40 PM
DatesSigned By DateUpdateNew Registration 1/7/2022 8:23:57 PM2/25/2022 12:40 PM
DatesStart DateUpdateNew Registration 4/1/2022 12:00:00 AM2/25/2022 12:40 PM
AddressesMain AddressInsertNew Registration  3581 Palmer Drive 202 Cameron Park, CA 956821/7/2022 3:36 PM
AddressesBilling AddressInsertNew Registration Marshall Medical Center P.O. Box 872 Placerville, CA 956671/7/2022 3:36 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/7/2022 3:36 PM
Medicaid BillingMedicaid: NumberInsertNew Registration HSP402541/7/2022 3:36 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA1/7/2022 3:36 PM
Medicaid BillingNPI: NumberInsertNew Registration 19725031421/7/2022 3:36 PM
Medicaid BillingNPI: StateInsertNew Registration CA1/7/2022 3:36 PM
ContactsAuthorizing OfficialInsertNew Registration Nelson, Siri CEO Marshall Medical Center 70734981271/7/2022 3:36 PM
ContactsPrimary ContactInsertNew Registration Godon, Stephanie A Director of Pharmacy Marshall Medical Center 53062627031/7/2022 3:36 PM
DetailsAssistance Received From DateInsertNew Registration  1/7/2022 3:36 PM
DetailsAssistance Received To DateInsertNew Registration  1/7/2022 3:36 PM
DetailsLast Recertification DateInsertNew Registration  1/7/2022 3:36 PM
DetailsGrant NumberInsertNew Registration  1/7/2022 3:36 PM
Details340B IDInsertNew Registration  1/7/2022 3:36 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/7/2022 3:36 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/7/2022 3:36 PM
DetailsMedicare Provider NumberInsertNew Registration 0502541/7/2022 3:36 PM
DetailsEntity NameInsertNew Registration MARSHALL HOSPITAL1/7/2022 3:36 PM
DetailsNOFO NumberInsertNew Registration  1/7/2022 3:36 PM
DetailsProgram CodeInsertNew Registration DSH1/7/2022 3:36 PM
DetailsEntity SubnameInsertNew Registration MMF Neurology1/7/2022 3:36 PM
DatesParticipating Approval DateInsertNew Registration  1/7/2022 3:36 PM
DetailsStateInsertNew Registration Pending1/7/2022 3:36 PM
DatesRegistration DateInsertNew Registration 1/7/2022 3:36:31 PM1/7/2022 3:36 PM
DatesSigned By DateInsertNew Registration  1/7/2022 3:36 PM
DatesStart DateInsertNew Registration  1/7/2022 3:36 PM
TerminationsTermination CommentsInsertNew Registration  1/7/2022 3:36 PM
TerminationsTermination DateInsertNew Registration  1/7/2022 3:36 PM
TerminationsTermination Effective DateInsertNew Registration  1/7/2022 3:36 PM
TerminationsTermination ReasonInsertNew Registration  1/7/2022 3:36 PM