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DSH050047F SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS (Terminated)
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Main Details
Name
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
Subdivision Name
CALIFORNIA PACIFIC MEDICAL CENTER-P / Pulmonary Function Lab,RT
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050047F
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
9/11/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
California Pacific Medical Center
HENRY YU, VP AND CFO
(415) 600-3850
Primary Contact
California Pacific Medical Center
Paul Knaus, Pharmacy IS Manager
(415) 600-3142
Addresses
Street Address
2351 CLAY ST
502-506
SAN FRANCISCO, CA 94115-1931
Billing Address
Sutter Shared Services Accounts Payable
PO Box 619110
Roseville, CA 95661
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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