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DSH050254AE MARSHALL HOSPITAL (Terminated)
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Main Details
Name
MARSHALL HOSPITAL
Subdivision Name
MARSHALL CARES - Addiction Treatment Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050254AE
Medicare Provider Number
050254
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/27/2020
Last Recertification Date
8/24/2023
Termination Date
Termination Reason
1/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Marshall Medical Center
Siri Nelson, CEO
(707) 349-8127
Primary Contact
Marshall Medical Center
Stephanie A Godon, Director of Pharmacy
(530) 626-2703
Addresses
Street Address
1045 Marshall Way
Placerville, CA 95667
Billing Address
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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