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DSH050441GN STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
STANFORD HEALTH CARE - CCSB Palliative Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441GN
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/26/2022
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
Stanford Health Care
Teresa Gross, 340B Business Analyst
(605) 937-3177
Addresses
Street Address
2589 SAMARITAN DR
3rd FL
SAN JOSE, CA 95124-4102
Billing Address
Stanford Health Care
300 Pasteur Drive
H0301
Stanford, CA 94305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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