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DSH050441EJ STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
CCSB Pain Management
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441EJ
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/7/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/24/2016
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford Health Care
Teresa Gross, 340B Business Analyst
(605) 937-3177
Addresses
Street Address
2589 Samaritan Drive
3rd FL
San Jose, CA 95124
Billing Address
Stanford Healthcare
300 Pasteur Drive
H0301
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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