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DSH050180A JOHN MUIR MEDICAL CENTER - WC (Approved)
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Main Details
Name
JOHN MUIR MEDICAL CENTER - WC
Subdivision Name
JM RAD ONCOLOGY OSCWC - Radiology-Diagnostic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050180A
Medicare Provider Number
050180
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/1/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/2/2025
Last Recertification Date
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
177 LA CASA VIA
STE 170
WALNUT CREEK, CA 94598-6101
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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