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DSH050454QU UCSF-MEDICAL CENTER (Terminated)
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Main Details
Name
UCSF-MEDICAL CENTER
Subdivision Name
Montgomery Acute Care - Montgomery Acute Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050454QU
Medicare Provider Number
050454
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/31/2019
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
10/1/2021
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
UCSF Health
James Bennan, COO Community Hospital Division
(415) 503-8667
Primary Contact
UCSF Health
Kayla Hubbard, 340B Program Coordinator
(808) 339-5697
Addresses
Street Address
1725 Montgomery Street, FL 2
San Francisco, CA 94111
Billing Address
UCSF MEDICAL CENTER
505 PARNASSUS AVE.
ROOM M39C
San Francisco, CA 94143
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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