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DSH050174D 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
St. Joseph Health - Outpatient Cancer Center Fountain Grove
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050174D
Medicare Provider Number
050174
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
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
3555 Round Barn Circle
Santa Rosa, CA 95403
Billing Address
ST Joseph Health Northern California LLC-DBA Santa Rosa Memorial Hospital
1165 Montgomery Drive
Santa Rosa, CA 95405
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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