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DSH050047G CALIFORNIA PACIFIC MEDICAL CENTER (Terminated)
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Main Details
Name
CALIFORNIA PACIFIC MEDICAL CENTER
Subdivision Name
CALIFORNIA PACIFIC MEDICAL CENTER-P / MRI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050047G
Medicare Provider Number
050047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
California Pacific Medical Center
HENRY YU, VP AND CFO
(415) 600-3850
Primary Contact
California Pacific Med Ctr
DON WILLIS, PHARMACY PURCH SYSTEMS MANAGER
(415) 600-3200
Addresses
Street Address
2351 CLAY ST 100
SAN FRANCISCO, CA 94115-1931
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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