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DSH050113 SAN MATEO MEDICAL CENTER (Active)
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Main Details
Name
SAN MATEO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050113
Medicare Provider Number
050113
Additional Details
Current Program Status
Active
Registration Date
9/7/2007
Participating Start Date
1/1/2005
Participating Approval Date
9/7/2007
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
San Mateo Medical Center
CHESTER J. KUNNAPPILLY, CEO
(650) 573-2305
Primary Contact
San Mateo Medical Center
Victor Armendariz, Director of Pharmacy
(650) 573-2366
Addresses
Street Address
222 WEST 39TH AVENUE
SAN MATEO, CA 94403
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/27/09 ADDED NPI#
05/11/2010
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