340B Drug Pricing Program Database
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DSH050113A SAN MATEO MEDICAL CENTER (Active)
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Main Details
Name
SAN MATEO MEDICAL CENTER
Subdivision Name
SAN MATEO COUNTY MEDICAL CENTER / Mobile Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050113A
Medicare Provider Number
050113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
San Mateo Medical Center
CHESTER J. KUNNAPPILLY, CEO
(650) 573-2305
Primary Contact
San Mateo Medical Center
Victor Armendariz, Director of Pharmacy
(650) 573-2366
Addresses
Street Address
222 W 39TH AVE
SAN MATEO, CA 94403
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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