340B Drug Pricing Program Database
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DSH050254D MARSHALL HOSPITAL (Active)
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Main Details
Name
MARSHALL HOSPITAL
Subdivision Name
DIVIDE WELLNESS CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050254D
Medicare Provider Number
050254
Outpatient Facility Provider Number
058514
Additional Details
Current Program Status
Active
Registration Date
1/5/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/1/2016
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
6065 HIGHWAY 193
GEORGETOWN, CA 95634
Billing Address
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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