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DSH050360G MARIN GENERAL HOSPITAL (Terminated)
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Main Details
Name
MARIN GENERAL HOSPITAL
Subdivision Name
2 Bon Air Cardiovascular Testing
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050360G
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
2 Bon Air Rd
Suite 140
Greenbrae, CA 94904
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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