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DSH050195A WASHINGTON HOSPITAL HEALTHCARE SYSTEM (Active)
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Main Details
Name
WASHINGTON HOSPITAL HEALTHCARE SYSTEM
Subdivision Name
Infusion Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050195A
Medicare Provider Number
050195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/25/2017
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Washington Hospital Healthcare System
Larry LaBossiere, SVP & COO
(510) 818-6586
Primary Contact
Washington Hospital Healthcare System
Minh-Thu Dennen, Director of Pharmacy
(510) 818-6114
Addresses
Street Address
2500 Mowry Ave
Fremont, CA 94538-1716
Billing Address
Washington Hospital Healthcare System
2000 Mowry Ave
Fremont, CA 94538
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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