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DSH050441FU STANFORD HEALTH CARE (Terminated)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
Blood and Marrow Transplant
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441FU
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/10/2020
Last Recertification Date
8/22/2024
Termination Date
Termination Reason
1/1/2025
Site closure
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
900 Blake Wilbur Dr
2nd FL
200S02
Palo Alto, CA 94304
Billing Address
Stanford Health Care
300 Pasteur Drive
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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