340B Drug Pricing Program Database
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DSH050441CH STANFORD HEALTH CARE (Terminated)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
Concierge Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441CH
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
6/3/2015
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
1/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford Health Care
Jannice Tan, Pharmacy Business Analyst, 340B
(510) 919-7483
Addresses
Street Address
900 Blake Wilbur Dr
2nd FL
W2001
Palo Alto, CA 94304
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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