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DSH050441GQ STANFORD HEALTH CARE (Active)
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Main Details
Name
STANFORD HEALTH CARE
Subdivision Name
BLOOD AND MARROW TRANSPLANT CLINIC - HEMATOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH050441GQ
Medicare Provider Number
050441
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/11/2022
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Stanford Health Care
Linda Hoff, CFO
(650) 497-0391
Primary Contact
STANFORD HEALTH CARE
Michele Martin, 340B Analyst
(425) 210-5740
Addresses
Street Address
875 Blake Wilbur Drive
1st Floor
Clinic E
Palo Alto, CA 94305
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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