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DSH050441F STANFORD HEALTH CARE (Terminated)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
STANFORD PRIMARY CARE-PORTOLA VALLEY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441F
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2015
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
Business decision by the Covered Entity
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford health care
Sinthusan Sinnadurai, Director
(650) 285-9974
Addresses
Street Address
3240 Alpine Road
Portola Valley, CA 94028-7523
Billing Address
Stanford Health Care
300 Pasteur Dr.
H0301
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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