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SUTTER HEALTH SPECIALTY PHARMACY @ ABSMC
DSH050047 SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
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Covered Entity Details
Entity Name
SUTTER BAY HOSPITALS DBA CPMC VAN NESS CAMPUS
Subdivision Name
CALIFORNIA PACIFIC MEDICAL CENTER PACIFIC CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH050047
Entity Address
1101 VAN NESS AVE
SAN FRANCISCO, CA 94109
Medicare Provider Number
050047
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
SUTTER HEALTH SPECIALTY PHARMACY @ ABSMC
Pharmacy Address
2001 DWIGHT WAY STE 2182
BERKELEY, CA 94704
Pharmacy Comments
Contract Details
Approval Date
1/24/2023
Contract Begin Date
1/31/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
HENRY YU, VP AND CFO
(415) 600-3850
Contract Pharmacy Representative
Sutter Health
Tapan Shah, Director Ambulatory Pharmacy
(510) 869-8454
Signed By Date
1/24/2023
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