340B Drug Pricing Program Database
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DSH050136B PETALUMA VALLEY HOSPITAL (Terminated)
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Main Details
Name
PETALUMA VALLEY HOSPITAL
Subdivision Name
PVH - Hospice of Petaluma
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050136B
Medicare Provider Number
050136
Outpatient Facility Provider Number
051557
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
8/16/2018
Termination Date
Termination Reason
1/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
St. Joseph Health
Kevin Klockenga, CEO
(707) 522-1520
Primary Contact
St.Joseph Health
Virginia Elizabeth Schuchard, NorCal Region 340B Program Manager
(507) 271-8661
Addresses
Street Address
416 Payran Street
Petaluma, CA 94952
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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