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DSH050441DH STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
OP CTR Spine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441DH
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/28/2016
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford Health Care
Muang Lopez, 340B Business Analyst
(707) 688-1874
Addresses
Street Address
420 Broadway St
Pav D, 1st FL
D15
Redwood City, CA 94063
Billing Address
Stanford Health Care Central Pharmacy
300 Pasteur Dr.
H0301
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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