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DSH050174N ST Joseph Health Northern California LLC-DBA Santa Rosa Memorial Hospital (Terminated)
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Main Details
Name
ST Joseph Health Northern California LLC-DBA Santa Rosa Memorial Hospital
Subdivision Name
SRMH - Non-Invasive Cardiology / Non-Invasive Cardiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050174N
Medicare Provider Number
050174
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Providence St. Joseph Health
Patti Pilgrim, Regional CFO
(707) 525-5323
Primary Contact
Providence St. Joseph Health
Caroline Chellamy, Regional Director, 340B Operations
(424) 259-3784
Addresses
Street Address
500 Doyle Park Drive
Suite G03
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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