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DSH050180 JOHN MUIR MEDICAL CENTER - WC (ToBeTerminated)
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Main Details
Name
JOHN MUIR MEDICAL CENTER - WC
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050180
Medicare Provider Number
050180
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/1/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/24/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
John Muir Health
Zach Harris, VP Ancillary Services
(808) 457-0157
Primary Contact
John Muir Health
Nikolai Tyler Dahl, Program Manager - Medication Utilization
(925) 947-3243
Addresses
Street Address
1601 YGNACIO VALLEY ROAD
WALNUT CREEK, CA 94598-3198
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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