340B Drug Pricing Program Database
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DSH050254AN MARSHALL HOSPITAL (Active)
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Main Details
Name
MARSHALL HOSPITAL
Subdivision Name
MARSHALL MEDICAL CENTER - RECOVERY - CAMERON PARK SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050254AN
Medicare Provider Number
050254
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/3/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/16/2024
Last Recertification Date
Contacts
Authorizing Official
Marshall Medical Center
Siri Nelson, CEO
(707) 349-8127
Primary Contact
Marshall Medical Center
Stephanie A Godon, Director of Pharmacy
(530) 626-2703
Addresses
Street Address
3501 PALMER DR 100
CAMERON PARK, CA 95682-8276
Billing Address
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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