Covered Entity Details

DSH050115P PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido) (Active) - information as of 5/3/2025 11:29:10 PM

Main Details

Name

PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)

Subdivision Name

Palomar Health Radiation Oncology - Radiation Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050115P

Medicare Provider Number

050115

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/6/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/13/2025

Last Recertification Date

Contacts

Authorizing Official

Palomar Health
Diane Lynette Hansen, President & CEO
(760) 740-6395

Primary Contact

Palomar Health
Dondreia Gelios, District Director Pharmacy Services
(442) 281-1358

Addresses

Street Address

2125 Citracado Parkway
Suite 110
Escondido, CA 92029

Billing Address

Palomar Health
120 Craven Road
San Marcos, CA 92078

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		1457321317
CO		1457321317
AZ		1457321317

Shipping Addresses

Shipping Address 1

PALOMAR HEALTH MEDICAL CENTER ESCONDIDO
2185 CITRACADO PARKWAY
ESCONDIDO, CA 92029

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
DSH050115B	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Palomar Health Expresscare- San Elijo Hills (San Marcos)	1571 San Elijo Rd	San Marcos	CA	Terminated
DSH050115C	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Palomar Health Expresscare- Temecula	30530 Rancho California Rd	Temecula	CA	Terminated
DSH050115D	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Palomar Health Expresscare- Escondido	1509 East Valley Parkway	Escondido	CA	Terminated
DSH050115E	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	PHDC Operating Room/ Surgical Platform	555 E. Valley Parkway	Escondido	CA	Terminated
DSH050115F	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Emergency Room	555 E. Valley Parkway	Escondido	CA	Terminated
DSH050115G	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Chemotherapy (Infusion Center)	2125 Citracado Pkwy	Escondido	CA	Active
DSH050115H	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Wound Care	2130 Citracado Parkway Suite 110A	San Escondido	CA	Active
DSH050115J	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Palomar Health Downtown Campus / Behavioral Health Services	555 E. Valley Parkway	Escondido	CA	Terminated
DSH050115K	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Palomar Outpatient Behavioral Health	125 Vallecitos De Oro, Suite A	San Marcos	CA	Terminated
DSH050115L	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Palomar Health Downtown Campus / PHDC Radiology Diagnostic	555 E. Valley Parkway	Escondido	CA	Terminated
DSH050115M	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Home Health	120 Craven Road	San Marcos	CA	Active
DSH050115N	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	PMC Escondido - Crisis Stabilization Unit	2185 Citracado Parkway	Escondido	CA	Active
DSH050115P	Child	DSH	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	Palomar Health Radiation Oncology - Radiation Oncology	2125 Citracado Parkway	Escondido	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Addresses	Shipping Address	Delete	New Registration	PALOMAR HEALTH MEDICAL CENTER ESCONDIDO 2185 CITRACADO PARKWAY ESCONDIDO, CA 92029		1/13/2025 7:01 AM
Addresses	Billing Address	Insert	New Registration		Palomar Health 120 Craven Road San Marcos, CA 92078	1/13/2025 7:01 AM
Addresses	Shipping Address	Insert	New Registration		PALOMAR HEALTH MEDICAL CENTER ESCONDIDO 2185 CITRACADO PARKWAY ESCONDIDO, CA 92029	1/13/2025 7:01 AM
Contacts	Signed By	Insert	New Registration		Hansen, Diane Lynette President & CEO Palomar Health 7607406395	1/13/2025 7:01 AM
Details	340B ID	Update	New Registration		DSH050115P	1/13/2025 7:01 AM
Details	Entity Name	Update	New Registration	PALOMAR MEDICAL CENTER ESCONDIDO	PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)	1/13/2025 7:01 AM
Details	Entity Subname	Update	New Registration	Palomar Health Radiation Oncology	Palomar Health Radiation Oncology - Radiation Oncology	1/13/2025 7:01 AM
Dates	Participating Approval Date	Update	New Registration		1/13/2025 7:01:50 AM	1/13/2025 7:01 AM
Details	State	Update	New Registration	Pending	Approved	1/13/2025 7:01 AM
Dates	Signed By Date	Update	New Registration		1/6/2025 7:02:11 PM	1/13/2025 7:01 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	1/13/2025 7:01 AM
Addresses	Billing Address	Insert	New Registration		Palomar Health 120 Craven Road San Marcos, CA 92078	1/6/2025 7:02 PM
Addresses	Shipping Address	Insert	New Registration		PALOMAR HEALTH MEDICAL CENTER ESCONDIDO 2185 CITRACADO PARKWAY ESCONDIDO, CA 92029	1/6/2025 7:02 PM
Addresses	Main Address	Insert	New Registration		2125 Citracado Parkway Suite 110 Escondido, CA 92029	1/6/2025 1:10 PM
Addresses	Billing Address	Insert	New Registration		Palomar Health 120 Craven Road San Marcos, CA 92078	1/6/2025 1:10 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1457321317	1/6/2025 1:10 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	1/6/2025 1:10 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1457321317	1/6/2025 1:10 PM
Medicaid Billing	NPI: State	Insert	New Registration		CO	1/6/2025 1:10 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1457321317	1/6/2025 1:10 PM
Medicaid Billing	NPI: State	Insert	New Registration		AZ	1/6/2025 1:10 PM
Contacts	Primary Contact	Insert	New Registration		Gelios, Dondreia District Director Pharmacy Services Palomar Health 4422811358	1/6/2025 1:10 PM
Contacts	Authorizing Official	Insert	New Registration		Hansen, Diane Lynette President & CEO Palomar Health 7607406395	1/6/2025 1:10 PM
Details	Assistance Received From Date	Insert	New Registration			1/6/2025 1:10 PM
Details	Assistance Received To Date	Insert	New Registration			1/6/2025 1:10 PM
Details	Last Recertification Date	Insert	New Registration			1/6/2025 1:10 PM
Details	Grant Number	Insert	New Registration			1/6/2025 1:10 PM
Details	340B ID	Insert	New Registration			1/6/2025 1:10 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/6/2025 1:10 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/6/2025 1:10 PM
Details	Medicare Provider Number	Insert	New Registration		050115	1/6/2025 1:10 PM
Details	Entity Name	Insert	New Registration		PALOMAR MEDICAL CENTER ESCONDIDO	1/6/2025 1:10 PM
Details	NOFO Number	Insert	New Registration			1/6/2025 1:10 PM
Details	Program Code	Insert	New Registration		DSH	1/6/2025 1:10 PM
Details	Entity Subname	Insert	New Registration		Palomar Health Radiation Oncology	1/6/2025 1:10 PM
Dates	Participating Approval Date	Insert	New Registration			1/6/2025 1:10 PM
Details	State	Insert	New Registration		Pending	1/6/2025 1:10 PM
Dates	Registration Date	Insert	New Registration		1/6/2025 1:10:10 PM	1/6/2025 1:10 PM
Dates	Signed By Date	Insert	New Registration			1/6/2025 1:10 PM
Dates	Start Date	Insert	New Registration			1/6/2025 1:10 PM
Terminations	Termination Comments	Insert	New Registration			1/6/2025 1:10 PM
Terminations	Termination Date	Insert	New Registration			1/6/2025 1:10 PM
Terminations	Termination Effective Date	Insert	New Registration			1/6/2025 1:10 PM
Terminations	Termination Reason	Insert	New Registration			1/6/2025 1:10 PM