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DSH050254N MARSHALL HOSPITAL (Terminated)
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Main Details
Name
MARSHALL HOSPITAL
Subdivision Name
MARSHALL UROLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050254N
Medicare Provider Number
050254
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/15/2024
Last Recertification Date
8/12/2024
Termination Date
Termination Reason
4/1/2025
Other
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
3501 PALMER DRIVE, SUITE 204
Cameron Park, CA 95682
Billing Address
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2016, terminated 10/1/2023. Reinstated 7/1/2024.
04/15/2024
April 2025
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