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DSH050100Z SHARP MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SHARP MEMORIAL HOSPITAL
Subdivision Name
Sharp-Clairemont Senior Health Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050100Z
Medicare Provider Number
050100
Outpatient Facility Provider Number
050100
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
Last Recertification Date
8/21/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Sharp Memorial Hospital
TIM SMITH, CEO
(858) 939-4082
Primary Contact
Sharp HealthCare
Susan Sachs, System Pharmacy Manager
(858) 499-4220
Addresses
Street Address
4320 Genesee Ave
Suite 104
San Diego, CA 92117
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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