340B Drug Pricing Program Database
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DSH050136 NorCal HealthConnect LLC, DBA Petaluma Valley Hospital (Active)
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Main Details
Name
NorCal HealthConnect LLC, DBA Petaluma Valley Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050136
Medicare Provider Number
050136
Additional Details
Current Program Status
Active
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/10/2015
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Providence St Joseph Health
Erika Wright, CFO
(707) 525-5300
Primary Contact
Providence
Jesse Peterson, 340B Program Director, South Division
(651) 324-2207
Addresses
Street Address
400 N. MCDOWELL BLVD
PETALUMA, CA 94954
Billing Address
Petaluma Valley Hospital
400 N. MCDOWELL BLVD
PETALUMA, CA 94954
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Parent hospital should not have a subdivision name.
04/24/2015
April 2025
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