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DSH050441BX STANFORD HOSPITAL & CLINICS (Terminated)
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Main Details
Name
STANFORD HOSPITAL & CLINICS
Subdivision Name
Cancer Clinic-Breast Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441BX
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
9/1/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Deepak Sisodiya, Director of Pharmacy Services
(650) 725-5801
Addresses
Street Address
900 Blake Wilbur Dr
Stanford, CA 94305
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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