340B Drug Pricing Program Database
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DSH050441EP STANFORD HEALTH CARE (Terminated)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
EHC - Urology - Urology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441EP
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/19/2018
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
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
5800 Hollis St.
Pav A 4th FL
Suite 4300
Emeryville, CA 94608
Billing Address
Stanford Health Care
300 Pasteur Drive
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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