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DSH050195C WASHINGTON HOSPITAL HEALTHCARE SYSTEM (Active)
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Main Details
Name
WASHINGTON HOSPITAL HEALTHCARE SYSTEM
Subdivision Name
Radiation Therapy - Radiation Oncology Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050195C
Medicare Provider Number
050195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/29/2025
Last Recertification Date
Contacts
Authorizing Official
Washington Hospital Healthcare System
Larry LaBossiere, SVP & COO
(510) 818-6586
Primary Contact
Washington Hospital Healthcare System
Minh-Thu Dennen, Director of Pharmacy
(510) 818-6114
Addresses
Street Address
39101 Civic Center Drive
Fremont, CA 94538
Billing Address
Washington Hospital HealthCare System
2000 MOWRY AVE
FREMONT, CA 94538
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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