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DSH050441DZ STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
CT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441DZ
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/8/2016
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
Jannice Tan, Pharmacy Business Analyst, 340B
(510) 919-7483
Addresses
Street Address
900 Blake Wilbur Dr
Garden Level
W0100
Palo Alto, CA 94304
Billing Address
Stanford Health Care Central Pharmacy
300 Pasteur Drive
H0301
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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