340B Drug Pricing Program Database
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DSH050360N MARIN GENERAL HOSPITAL (Terminated)
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Main Details
Name
MARIN GENERAL HOSPITAL
Subdivision Name
MARINHEALTH OUTPATIENT IMAGING CENTER - IMAGING
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050360N
Medicare Provider Number
050360
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/24/2023
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Marin General Hospital
Elizabeth Lasnier, Controller
(415) 925-7449
Primary Contact
Marin General Hospital
Megan Engler, 340B Coordinator
(415) 328-1454
Addresses
Street Address
1240 SOUTH ELISEO DRIVE
103
GREENBRAE, CA 94904
Billing Address
Marin Health Medical Center
250 Bon Air Road
Greenbrae, CA 94904
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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