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DSH050047AE SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS (Active)
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Main Details
Name
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
Subdivision Name
CPMC Imaging Services - MRI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050047AE
Medicare Provider Number
050047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/12/2021
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
California Pacific Medical Center
HENRY YU, VP AND CFO
(415) 600-3850
Primary Contact
Sutter Health
Rachel L Dunbar, 340B Analyst
(916) 952-3480
Addresses
Street Address
1100 Van Ness Avenue
2nd Floor
Rooms 2547, 2550
San Francisco, CA 94109-6919
Billing Address
Sutter Health
PO Box 619110
Roseville, CA 95661
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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