340B Drug Pricing Program Database


DSH050557E Sutter Valley Hospitals DBA Memorial Medical Center (Active) - information as of 4/25/2025 5:41:13 PM

Main Details
Sutter Valley Hospitals DBA Memorial Medical Center
Memorial Medical Center Modesto - Infusion Clinic
Disproportionate Share Hospital
No
DSH050557E
050557


Additional Details
Active
7/11/2023
10/1/2023
7/13/2023
9/3/2024

Contacts

Sutter Health
David Scott Wartelle, CFO - Greater Central Valley Market
(209) 572-7009

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

Addresses

1800 Coffee Rd
Suite #52
Modesto, CA 95355

Sutter Shared Services
P. O. Box 619110
Accounts Payable
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
CAHSC00557F HSP40557F1699129601
AL 1699129601
AK 1699129601
AZ 1699129601
CT 1699129601
DE 1699129601
DC 1699129601
FL 1699129601
GA 1699129601
HI 1699129601
KS 1699129601
ME 1699129601
MD 1699129601
MA 1699129601
MI 1699129601
MO 1699129601
MT 1699129601
NE 1699129601
NV 1699129601
NH 1699129601
NJ 1699129601
NM 1699129601
OH 1699129601
OK 1699129601
PA 1699129601
RI 1699129601
SC 1699129601
SD 1699129601
TX 1699129601
VT 1699129601
WA 1699129601
WY 1699129601
AR 1699129601
CO 1699129601
ID 1699129601
IL 1699129601
IA 1699129601
KY 1699129601
LA 1699129601
MN 1699129601
MS 1699129601
NY 1699129601
NC 1699129601
ND 1699129601
OR 1699129601
TN 1699129601
UT 1699129601
VA 1699129601
WV 1699129601
WI 1699129601
Shipping Addresses

Memorial Medical Center Modesto
1700 Coffee Rd
Modesto, CA 95355

Memorial Medical Center
1700 Coffee Road
N Tower 2nd FL
Modesto, CA 95355
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050557AChildDSHSutter Valley Hospitals DBA Memorial Medical CenterOutpatient Services-Trauma Clinic1401 Spanos CtModestoCAActive
DSH050557BChildDSHSutter Valley Hospitals DBA Memorial Medical CenterSpanos Court Surgery Center1401 Spanos Court Suite 200ModestoCAActive
DSH050557CChildDSHSutter Valley Hospitals DBA Memorial Medical CenterMemorial Hospital Modesto MRI - MRI1700 Coffee RoadModestoCAActive
DSH050557DChildDSHSutter Valley Hospitals DBA Memorial Medical CenterCardiac Independence Program - Cardiac rehab1800 Coffee RdModestoCAActive
DSH050557EChildDSHSutter Valley Hospitals DBA Memorial Medical CenterMemorial Medical Center Modesto - Infusion Clinic1800 Coffee RdModestoCAActive
DSH050557FChildDSHSutter Valley Hospitals DBA Memorial Medical CenterWest Family Heart & Vascular - Institute1329 Spanos Ct.ModestoCAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesMain AddressUpdateChange Request 1800 Coffee Rd Suite #52 & 85 Modesto, CA 95355 1800 Coffee Rd Suite #52 Modesto, CA 953554/16/2025 6:29 AM
ContactsPrimary ContactUpdateGroup Change RequestDunbar, Rachel 340B Analyst Sutter Health 9169523480Dunbar, Rachel L 340B Analyst Sutter Health 916952348012/12/2024 12:24 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request AR9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request CO9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request ID9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request IL9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request IA9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request KY9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request LA9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request MN9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request MS9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request NY9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request NC9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request ND9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request OR9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request TN9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request UT9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request VA9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request WV9/25/2024 10:35 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296019/25/2024 10:35 AM
Medicaid BillingNPI: StateInsertGroup Change Request WI9/25/2024 10:35 AM
DetailsLast Recertification DateUpdateRecertification 9/3/2024 10:33:49 AM9/3/2024 10:33 AM
ContactsPrimary ContactUpdateProfile Change RequestDunbar, Rachel Valley 340B Analyst Sutter Health 9169523480Dunbar, Rachel 340B Analyst Sutter Health 91695234806/24/2024 4:44 PM
ContactsAuthorizing OfficialUpdateChange RequestRoman, Tracy Chief Financial Officer Sutter Health 2095727288Wartelle, David Scott CFO - Greater Central Valley Market Sutter Health 20957270094/1/2024 7:30 AM
AddressesMain AddressUpdateChange Request 1800 Coffee Rd Suite #52 Modesto, CA 95355 1800 Coffee Rd Suite #52 & 85 Modesto, CA 953553/7/2024 8:12 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/19/2024 2:30 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16991296011/19/2024 2:30 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/19/2024 2:30 AM
DetailsStateUpdate ApprovedActive10/1/2023 12:01 AM
AddressesShipping AddressInsertChange Request Memorial Medical Center 1700 Coffee Road N Tower 2nd FL Modesto, CA 953558/22/2023 7:24 AM
ContactsPrimary ContactUpdateGroup Change RequestMinger, Patricia Pharmacy Technician Analyst Sutter Health 4156003202Dunbar, Rachel Valley 340B Analyst Sutter Health 91695234808/10/2023 10:59 AM
Medicaid BillingMedicaid: NumberDeleteNew Registration05-0557 (CA) 7/13/2023 1:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/13/2023 1:15 PM
Medicaid BillingMedicaid: NumberInsertNew Registration HSC00557F HSP40557F7/13/2023 1:15 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA7/13/2023 1:15 PM
ContactsSigned ByInsertNew Registration Roman, Tracy Chief Financial Officer Sutter Health 20957272887/13/2023 1:15 PM
Details340B IDUpdateNew Registration DSH050557E7/13/2023 1:15 PM
DetailsEntity NameUpdateNew RegistrationMEMORIAL HOSPITAL MODESTOSutter Valley Hospitals DBA Memorial Medical Center7/13/2023 1:15 PM
DetailsEntity SubnameUpdateNew RegistrationMemorial Medical Center ModestoMemorial Medical Center Modesto - Infusion Clinic7/13/2023 1:15 PM
DatesParticipating Approval DateUpdateNew Registration 7/13/2023 1:15:36 PM7/13/2023 1:15 PM
DetailsStateUpdateNew RegistrationPendingApproved7/13/2023 1:15 PM
DatesSigned By DateUpdateNew Registration 7/13/2023 11:08:05 AM7/13/2023 1:15 PM
DatesStart DateUpdateNew Registration 10/1/2023 12:00:00 AM7/13/2023 1:15 PM
AddressesMain AddressInsertNew Registration  1800 Coffee Rd Suite #52 Modesto, CA 953557/11/2023 11:30 AM
AddressesBilling AddressInsertNew Registration Sutter Shared Services P. O. Box 619110 Accounts Payable Roseville, CA 956617/11/2023 11:30 AM
AddressesShipping AddressInsertNew Registration Memorial Medical Center Modesto 1700 Coffee Rd Modesto, CA 953557/11/2023 11:30 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/11/2023 11:30 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 05-05577/11/2023 11:30 AM
Medicaid BillingMedicaid: StateInsertNew Registration CA7/11/2023 11:30 AM
Medicaid BillingNPI: NumberInsertNew Registration 16991296017/11/2023 11:30 AM
Medicaid BillingNPI: StateInsertNew Registration CA7/11/2023 11:30 AM
ContactsPrimary ContactInsertNew Registration Minger, Patricia Pharmacy Technician Analyst Sutter Health 41560032027/11/2023 11:30 AM
ContactsAuthorizing OfficialInsertNew Registration Roman, Tracy Chief Financial Officer Sutter Health 20957272887/11/2023 11:30 AM
DetailsAssistance Received From DateInsertNew Registration  7/11/2023 11:30 AM
DetailsAssistance Received To DateInsertNew Registration  7/11/2023 11:30 AM
DetailsLast Recertification DateInsertNew Registration  7/11/2023 11:30 AM
DetailsGrant NumberInsertNew Registration  7/11/2023 11:30 AM
Details340B IDInsertNew Registration  7/11/2023 11:30 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/11/2023 11:30 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/11/2023 11:30 AM
DetailsMedicare Provider NumberInsertNew Registration 0505577/11/2023 11:30 AM
DetailsEntity NameInsertNew Registration MEMORIAL HOSPITAL MODESTO7/11/2023 11:30 AM
DetailsNOFO NumberInsertNew Registration  7/11/2023 11:30 AM
DetailsProgram CodeInsertNew Registration DSH7/11/2023 11:30 AM
DetailsEntity SubnameInsertNew Registration Memorial Medical Center Modesto7/11/2023 11:30 AM
DatesParticipating Approval DateInsertNew Registration  7/11/2023 11:30 AM
DetailsStateInsertNew Registration Pending7/11/2023 11:30 AM
DatesRegistration DateInsertNew Registration 7/11/2023 11:30:40 AM7/11/2023 11:30 AM
DatesSigned By DateInsertNew Registration  7/11/2023 11:30 AM
DatesStart DateInsertNew Registration  7/11/2023 11:30 AM
TerminationsTermination CommentsInsertNew Registration  7/11/2023 11:30 AM
TerminationsTermination DateInsertNew Registration  7/11/2023 11:30 AM
TerminationsTermination Effective DateInsertNew Registration  7/11/2023 11:30 AM
TerminationsTermination ReasonInsertNew Registration  7/11/2023 11:30 AM