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DSH050360B MARIN GENERAL HOSPITAL (Terminated)
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Main Details
Name
MARIN GENERAL HOSPITAL
Subdivision Name
Marin Outpatient Imaging Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050360B
Medicare Provider Number
050360
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/18/2016
Last Recertification Date
Termination Date
Termination Reason
4/1/2016
Other
Contacts
Authorizing Official
Marin General Hospital
Elizabeth Lasnier, Controller
(415) 925-7449
Primary Contact
Marin General Hospital
Michael Sillman, Director of Pharmacy
(415) 925-7867
Addresses
Street Address
1240 S Eliseo Dr
Suite 103
Greenbrae, CA 94904
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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