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DSH050254 MARSHALL HOSPITAL (Active)
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Main Details
Name
MARSHALL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050254
Medicare Provider Number
050254
Additional Details
Current Program Status
Active
Registration Date
10/13/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/26/2015
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Marshall Medical Center
Siri Nelson, CEO
(707) 349-8127
Primary Contact
Marshall Medical Center
Stephanie A Godon, Director of Pharmacy
(530) 626-2703
Addresses
Street Address
1100 MARSHALL WAY
PLACERVILLE, CA 95667
Billing Address
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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