Covered Entity Details

DSH050276AB CONTRA COSTA REGIONAL MEDICAL CENTER (Approved) - information as of 5/26/2025 12:48:27 AM

Main Details

Name

CONTRA COSTA REGIONAL MEDICAL CENTER

Subdivision Name

CONTRA COSTA COUNTY - Adult Medicine Clinic WCHC

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050276AB

Medicare Provider Number

050276

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/8/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/12/2025

Last Recertification Date

Contacts

Authorizing Official

Contra Costa Health Services
Brian Buchanan, Interim Chief Financial Officer
(925) 957-5410

Primary Contact

Contra Costa Health
Robert H De Cesare, Fiscal Manager
(925) 957-5429

Addresses

Street Address

13601 SAN PABLO AVE
SAN PABLO, CA 94806-3818

Billing Address

Contra Costa Regional Medical Center Outpatient Pharmacy
2500 Alhambra Ave
Building 1
Martinez, CA 94553-3156

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	FHC80100F,HAP80100F	1962587071,1417036484

Shipping Addresses

Shipping Address 1

Contra Costa Regional Medical Center Outpatient Pharmacy
2500 Alhambra Ave
Building 1
Martinez, CA 94553-3156

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
DSH050276A	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	WEST COUNTY HEALTH CENTER	West County Health Center	San Pablo	CA	Active
DSH050276AA	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - Nursing Visit	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AB	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Adult Medicine Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AC	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - Mental Health Clinic	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AD	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - Adult Medicine Clinic	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AE	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Family Practice Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AF	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Audiology Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AG	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Med Pain Consult Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AH	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - SBC	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AJ	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - Family Practice Clinic	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AK	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - Pediatrics Clinic	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AL	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Integrative Medicine Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AM	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - Women's Health Clinic	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AN	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - ENT Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AP	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Antepartum Testing WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AQ	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Homeless Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AR	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Dermatology Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AS	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Gynecology Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AT	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Choosing Change Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AU	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Cardiology Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AV	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT HEALTH CENTER - Telephone Clinic	215 PACIFICA AVE	BAY POINT	CA	Approved
DSH050276AW	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - H&P Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AX	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Gastroenterology Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AY	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Internal Medicine Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276AZ	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Cardiopulmonary Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276B	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	PITTSBURG HEALTH CENTER	PITTSBURG HEALTH CENTER	PITTSBURG	CA	Active
DSH050276BA	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Hepatology Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276BB	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Dysplasia Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276BC	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - High Risk Pregnancy Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276BD	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Medical Group Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276C	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONCORD HEALTH CENTER	CONCORD HEALTH CENTER	CONCORD	CA	Active
DSH050276D	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	NORTH RICHMOND CENTER FOR HEALTH	NORTH RICHMOND CENTER FOR HEALTH	NORTH RICHMOND	CA	Active
DSH050276E	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	ANTIOCH HEALTH CENTER	ANTIOCH HEALTH CENTER	ANTIOCH	CA	Active
DSH050276F	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BAY POINT FAMILY HEALTH CENTER	BAY POINT FAMILY HEALTH CENTER	BAY POINT	CA	Active
DSH050276G	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	BRENTWOOD HEALTH CENTER	BRENTWOOD HEALTH CENTER	BRENTWOOD	CA	Active
DSH050276H	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA REGIONAL MEDICAL CENTER CLINIC	CONTRA COSTA REGIONAL MEDICAL CENTER CLINIC	MARTINEZ	CA	Terminated
DSH050276I	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	MARTINEZ SPECIALTY CLINIC	MARTINEZ SPECIALTY CLINIC	MARTINEZ	CA	Active
DSH050276J	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	EL CERRITO HEALTH CENTER	EL CERRITO HEALTH CENTER	CONCORD	CA	Terminated
DSH050276K	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Willow Pass Wellness Center	WILLOW PASS WELLNESS CENTER	Concord	CA	Terminated
DSH050276L	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Concord Health Center #2	Concord Health Center #2	Concord	CA	Active
DSH050276M	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Mobile Clinic Vans	Mobile Clinic Vans	Martinez	CA	Active
DSH050276N	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Richmond Healthy Start	Richmond Healthy Start	Richmond	CA	Terminated
DSH050276P	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Concord Healthy Start	Concord Healthy Start	Concord	CA	Terminated
DSH050276Q	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Antioch Healthy Start	Antioch Healthy Start	Antioch	CA	Terminated
DSH050276R	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	George and Cynthia Miller Wellness Center	George and Cynthia Miller Wellness Center	Martinez	CA	Active
DSH050276T	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	El Cerrito High School - Family Practice	540 Ashbury Ave	El Cerrito	CA	Active
DSH050276U	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Kennedy High School - Family Practice/Dental	4300 Cutting Blvd	Richmond	CA	Active
DSH050276V	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	DeAnza High School - Family Practice/Dental	5000 Valley View Rd	Richmond	CA	Active
DSH050276W	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Philip Dorn Respite Shelter - Family Practice/Dental	2047 Arnold Industrial Way	Concord	CA	Active
DSH050276X	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	Richmond High School - Family Practice/Dental	1250 23rd Street	Richmond	CA	Active
DSH050276Y	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Dietary Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved
DSH050276Z	Child	DSH	CONTRA COSTA REGIONAL MEDICAL CENTER	CONTRA COSTA COUNTY - Chest Clinic WCHC	13601 SAN PABLO AVE	SAN PABLO	CA	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Buchanan, Brian Interim Chief Financial Officer Contra Costa Health Services 9259575410	5/12/2025 9:31 AM
Details	340B ID	Update	New Registration		DSH050276AB	5/12/2025 9:31 AM
Details	Entity Subname	Update	New Registration	CONTRA COSTA COUNTY	CONTRA COSTA COUNTY - Adult Medicine Clinic WCHC	5/12/2025 9:31 AM
Dates	Participating Approval Date	Update	New Registration		5/12/2025 9:31:32 AM	5/12/2025 9:31 AM
Details	State	Update	New Registration	Pending	Approved	5/12/2025 9:31 AM
Dates	Signed By Date	Update	New Registration		4/30/2025 10:30:43 AM	5/12/2025 9:31 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/12/2025 9:31 AM
Addresses	Billing Address	Insert	New Registration		Contra Costa Regional Medical Center Outpatient Pharmacy 2500 Alhambra Ave Building 1 Martinez, CA 94553-3156	4/9/2025 12:05 PM
Addresses	Shipping Address	Insert	New Registration		Contra Costa Regional Medical Center Outpatient Pharmacy 2500 Alhambra Ave Building 1 Martinez, CA 94553-3156	4/9/2025 12:05 PM
Addresses	Main Address	Insert	New Registration		13601 SAN PABLO AVE SAN PABLO, CA 94806-3818	4/8/2025 3:08 PM
Addresses	Billing Address	Insert	New Registration		Contra Costa Regional Medical Center Outpatient Pharmacy 2500 Alhambra Ave Building 1 Martinez, CA 94553-3156	4/8/2025 3:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/8/2025 3:08 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		FHC80100F	4/8/2025 3:08 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	4/8/2025 3:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/8/2025 3:08 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HAP80100F	4/8/2025 3:08 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	4/8/2025 3:08 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1962587071	4/8/2025 3:08 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/8/2025 3:08 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1417036484	4/8/2025 3:08 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/8/2025 3:08 PM
Contacts	Primary Contact	Insert	New Registration		De Cesare, Robert H Fiscal Manager Contra Costa Health 9259575429	4/8/2025 3:08 PM
Contacts	Authorizing Official	Insert	New Registration		Buchanan, Brian Interim Chief Financial Officer Contra Costa Health Services 9259575410	4/8/2025 3:08 PM
Details	Assistance Received From Date	Insert	New Registration			4/8/2025 3:08 PM
Details	Assistance Received To Date	Insert	New Registration			4/8/2025 3:08 PM
Details	Last Recertification Date	Insert	New Registration			4/8/2025 3:08 PM
Details	Grant Number	Insert	New Registration			4/8/2025 3:08 PM
Details	340B ID	Insert	New Registration			4/8/2025 3:08 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/8/2025 3:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/8/2025 3:08 PM
Details	Medicare Provider Number	Insert	New Registration		050276	4/8/2025 3:08 PM
Details	Entity Name	Insert	New Registration		CONTRA COSTA REGIONAL MEDICAL CENTER	4/8/2025 3:08 PM
Details	NOFO Number	Insert	New Registration			4/8/2025 3:08 PM
Details	Program Code	Insert	New Registration		DSH	4/8/2025 3:08 PM
Details	Entity Subname	Insert	New Registration		CONTRA COSTA COUNTY	4/8/2025 3:08 PM
Dates	Participating Approval Date	Insert	New Registration			4/8/2025 3:08 PM
Details	State	Insert	New Registration		Pending	4/8/2025 3:08 PM
Dates	Registration Date	Insert	New Registration		4/8/2025 3:08:59 PM	4/8/2025 3:08 PM
Dates	Signed By Date	Insert	New Registration			4/8/2025 3:08 PM
Dates	Start Date	Insert	New Registration			4/8/2025 3:08 PM
Terminations	Termination Comments	Insert	New Registration			4/8/2025 3:08 PM
Terminations	Termination Date	Insert	New Registration			4/8/2025 3:08 PM
Terminations	Termination Effective Date	Insert	New Registration			4/8/2025 3:08 PM
Terminations	Termination Reason	Insert	New Registration			4/8/2025 3:08 PM