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DSH050457D ST. MARY'S MEDICAL CENTER (Terminated)
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Main Details
Name
ST. MARY'S MEDICAL CENTER
Subdivision Name
Spine Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050457D
Medicare Provider Number
050457
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/2/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
St. Mary's Dignity Health
Sherie Ambrose, Vice President/ Chief Nurse Executive/ COO
(415) 750-5716
Primary Contact
St. Mary's Medical Center
Minh Thu Nguyen, Director of Pharmacy
(415) 750-4988
Addresses
Street Address
1 Shrader Street
San Francisco, CA 94117
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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