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DSH050441FH STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
IMMUNOLOGY DERM - OC - Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441FH
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/26/2018
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford Health Care
Muang Lopez, 340B Business Analyst
(707) 688-1874
Addresses
Street Address
440 Broadway St
Pav B, 4th FL
B41
Redwood City, CA 94063
Billing Address
Stanford Health Care
300 Pasteur Drive
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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