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DSH050441BY STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
Cancer Clinic-GI Oncology-BW
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441BY
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/2/2017
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
STANFORD HEALTH CARE
Michele Martin, 340B Analyst
(425) 210-5740
Addresses
Street Address
875 Blake Wilbur Dr
1st FL
Clinic B
Palo Alto, CA 94304
Billing Address
Stanford Health Care
300 Pasteur Dr.
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating 7/1/2015 until terminated effective 10/1/2016, reinstated effective 1/1/2018
10/19/2017
April 2025
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