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DSH050100AA SHARP MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
SHARP MEMORIAL HOSPITAL
Subdivision Name
Sharp Downtown Senior Health Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050100AA
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
956 Tenth Ave
San Diego, CA 92101
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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