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DSH050454AX UCSF-MEDICAL CENTER (Terminated)
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Main Details
Name
UCSF-MEDICAL CENTER
Subdivision Name
Dermatology Consult
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050454AX
Medicare Provider Number
050454
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/17/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/26/2012
Last Recertification Date
9/3/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
UCSF Health
James Bennan, COO Community Hospital Division
(415) 503-8667
Primary Contact
Tony Davoren, Director of Finance
(415) 514-6013
Addresses
Street Address
1701 Divisadero St 3rd floor
San Francisco, CA 94115
Billing Address
UCSF-MEDICAL CENTER
505 PARNASSUS AVE. ROOM M39C
San Francisco, CA 94143
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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