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DSH050441CT STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
Pain Management
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441CT
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/9/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/15/2015
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford Health Care
Muang Lopez, 340B Business Analyst
(707) 688-1874
Addresses
Street Address
450 Broadway St
Pav A, 1st FL
A18
Redwood City, CA 94063
Billing Address
Stanford Health Care
300 Pasteur Dr.
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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