Covered Entity Details

DSH050272E REDLANDS COMMUNITY HOSPITAL (Active) - information as of 5/27/2025 2:28:36 PM

Main Details

Name

REDLANDS COMMUNITY HOSPITAL

Subdivision Name

Center for Surgical and Specialty Care - Vascular - Vascular Care

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050272E

Medicare Provider Number

050272

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/8/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/7/2024

Last Recertification Date

Contacts

Authorizing Official

Redlands Community Hospital
Todd J Sexton, Vice President, Professional and General Services
(909) 335-6423

Primary Contact

Redlands Community Hospital
Justin D Miles, Director of Pharmacy
(909) 335-6451

Addresses

Street Address

350 Terracina Blvd
Redlands, CA 92373

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
CA	050272	1043354111

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH050272A	Child	DSH	REDLANDS COMMUNITY HOSPITAL	Redlands Family Clinic - Family Practice	802 W. Colton	Redlands	CA	Active
DSH050272B	Child	DSH	REDLANDS COMMUNITY HOSPITAL	Yucaipa Family Clinic - Family Practice	11985 4th Street	Yucaipa	CA	Active
DSH050272C	Child	DSH	REDLANDS COMMUNITY HOSPITAL	Center for Surgical and Specialty Care (CSSC) - Specialty Clinic	255 Terracina Blvd	Redlands	CA	Active
DSH050272D	Child	DSH	REDLANDS COMMUNITY HOSPITAL	Center for Cancer Care - Infusion Therapy	245 Terracina Blvd	Redlands	CA	Active
DSH050272E	Child	DSH	REDLANDS COMMUNITY HOSPITAL	Center for Surgical and Specialty Care - Vascular - Vascular Care	350 Terracina Blvd	Redlands	CA	Active
DSH050272F	Child	DSH	REDLANDS COMMUNITY HOSPITAL	Center for Surgical and Specialty Care - Neurology - Neurology Institute	350 Terracina Blvd	Redlands	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Sexton, Todd J Vice President, Professional and General Services Redlands Community Hospital 9093356423	8/7/2024 10:17 AM
Details	340B ID	Update	New Registration		DSH050272E	8/7/2024 10:17 AM
Details	Entity Subname	Update	New Registration	Center for Surgical and Specialty Care - Vascular	Center for Surgical and Specialty Care - Vascular - Vascular Care	8/7/2024 10:17 AM
Dates	Participating Approval Date	Update	New Registration		8/7/2024 10:17:27 AM	8/7/2024 10:17 AM
Details	State	Update	New Registration	Pending	Approved	8/7/2024 10:17 AM
Dates	Signed By Date	Update	New Registration		8/2/2024 4:59:51 PM	8/7/2024 10:17 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/7/2024 10:17 AM
Addresses	Main Address	Insert	New Registration		350 Terracina Blvd Redlands, CA 92373	7/8/2024 2:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2024 2:13 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		050272	7/8/2024 2:13 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	7/8/2024 2:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1043354111	7/8/2024 2:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	7/8/2024 2:13 PM
Contacts	Authorizing Official	Insert	New Registration		Sexton, Todd J Vice President, Professional and General Services Redlands Community Hospital 9093356423	7/8/2024 2:13 PM
Contacts	Primary Contact	Insert	New Registration		Miles, Justin D Director of Pharmacy Redlands Community Hospital 9093356451	7/8/2024 2:13 PM
Details	Assistance Received From Date	Insert	New Registration			7/8/2024 2:13 PM
Details	Assistance Received To Date	Insert	New Registration			7/8/2024 2:13 PM
Details	Last Recertification Date	Insert	New Registration			7/8/2024 2:13 PM
Details	Grant Number	Insert	New Registration			7/8/2024 2:13 PM
Details	340B ID	Insert	New Registration			7/8/2024 2:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/8/2024 2:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/8/2024 2:13 PM
Details	Medicare Provider Number	Insert	New Registration		050272	7/8/2024 2:13 PM
Details	Entity Name	Insert	New Registration		REDLANDS COMMUNITY HOSPITAL	7/8/2024 2:13 PM
Details	NOFO Number	Insert	New Registration			7/8/2024 2:13 PM
Details	Program Code	Insert	New Registration		DSH	7/8/2024 2:13 PM
Details	Entity Subname	Insert	New Registration		Center for Surgical and Specialty Care - Vascular	7/8/2024 2:13 PM
Dates	Participating Approval Date	Insert	New Registration			7/8/2024 2:13 PM
Details	State	Insert	New Registration		Pending	7/8/2024 2:13 PM
Dates	Registration Date	Insert	New Registration		7/8/2024 2:13:29 PM	7/8/2024 2:13 PM
Dates	Signed By Date	Insert	New Registration			7/8/2024 2:13 PM
Dates	Start Date	Insert	New Registration			7/8/2024 2:13 PM
Terminations	Termination Comments	Insert	New Registration			7/8/2024 2:13 PM
Terminations	Termination Date	Insert	New Registration			7/8/2024 2:13 PM
Terminations	Termination Effective Date	Insert	New Registration			7/8/2024 2:13 PM
Terminations	Termination Reason	Insert	New Registration			7/8/2024 2:13 PM