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DSH050047AB SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS (Terminated)
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Main Details
Name
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
Subdivision Name
ELECTROCARDIOLOGY - NON-INVASIVE CARDIO-EKG
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050047AB
Medicare Provider Number
050047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/18/2018
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
California Pacific Medical Center
HENRY YU, VP AND CFO
(415) 600-3850
Primary Contact
California Pacific Medical Center
Paul Knaus, Pharmacy IS Manager
(415) 600-3142
Addresses
Street Address
2333 BUCHANAN ST
FIRST FLOOR
SAN FRANCISCO, CA 94115
Billing Address
Sutter Shared Services Accounts Payable
Po Box 619110
Roseville, CA 95661
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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