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DSH050441AK STANFORD HEALTH CARE (Terminated)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
Clinic-Orthopaedics-Portola Valley
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441AK
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/26/2015
Participating Start Date
7/1/2015
Participating Approval Date
6/2/2015
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford Health Care
Caroline Chellamy, Assistant Director of Pharmacy Services
(650) 724-7812
Addresses
Street Address
3260 Alpine Rd
Portola Valley, CA 94028
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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