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DSH050174B ST Joseph Health Northern California LLC-DBA Santa Rosa Memorial Hospital (Active)
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Main Details
Name
ST Joseph Health Northern California LLC-DBA Santa Rosa Memorial Hospital
Subdivision Name
SRMH - Diagnostic Radiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050174B
Medicare Provider Number
050174
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/17/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/11/2022
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
121 Sotoyome
Santa Rosa, CA 95405
Billing Address
Santa Rosa Memorial Hospital
1165 Montgomery Drive
Santa Rosa, CA 95405
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (4/1/2015) until terminated effective date: (10/01/2020), reinstatement effective date: (04/01/2022)
02/11/2022
April 2025
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