340B Drug Pricing Program Database


DSH050291 Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital (Active) - information as of 6/8/2025 12:59:01 AM

Main Details
Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital
dba Sutter Santa Rosa Regional Hospital
Disproportionate Share Hospital
No
DSH050291
050291


Additional Details
Active
7/1/2005
7/1/2005
6/2/2005
8/13/2024

Contacts

Sutter Health
Henry Yu, Chief Financial Officer, West Bay
(415) 600-3850

Sutter Health
Rachel L Dunbar, 340B Analyst
(916) 952-3480

Addresses

30 MARK WEST SPRINGS ROAD
SANTA ROSA, CA 95403

Sutter Shared Services
PO Box 619110
Accounts Payable
Roseville, CA 95661


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
2/22/12 UPDATE MEDICAID # FROM PHB418780 02/22/2012
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CAHSP40291G,ZZR00291G1740413798
AL 1740413798
AK 1740413798
AZ 1740413798
CT 1740413798
DE 1740413798
DC 1740413798
FL 1740413798
GA 1740413798
HI 1740413798
KS 1740413798
ME 1740413798
MD 1740413798
MA 1740413798
MI 1740413798
MO 1740413798
MT 1740413798
NE 1740413798
NV 1740413798
NH 1740413798
NJ 1740413798
NM 1740413798
OH 1740413798
OK 1740413798
PA 1740413798
RI 1740413798
SC 1740413798
SD 1740413798
TX 1740413798
VT 1740413798
WA 1740413798
WY 1740413798
AR 1740413798
CO 1740413798
ID 1740413798
IL 1740413798
IA 1740413798
KY 1740413798
LA 1740413798
MN 1740413798
MS 1740413798
NY 1740413798
NC 1740413798
ND 1740413798
OR 1740413798
TN 1740413798
UT 1740413798
VA 1740413798
WV 1740413798
WI 1740413798
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/14/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/14/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/14/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/14/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/14/202210/01/2022  10/01/2022
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/14/202210/01/2022 05/31/202306/08/2023
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/14/202210/01/2022  10/01/2022
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/18/202211/01/2022  11/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/18/202211/01/2022  11/01/2022
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/18/202211/01/2022  11/01/2022
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/18/202211/01/2022  11/01/2022
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/18/202211/01/2022  11/01/2022
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/14/202210/01/2022  10/01/2022
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/14/202210/01/2022  10/01/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/14/202210/01/2022  10/01/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/14/202210/01/2022  10/01/2022
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09946 463 STONY POINT RD
SANTA ROSACA9540110/18/202211/01/2022 01/27/202501/27/2025
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/20/202301/31/2023  01/31/2023
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502901/20/202301/31/2023  01/31/2023
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713001/20/202301/31/2023  01/31/2023
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729801/20/202301/31/2023  01/31/2023
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140101/20/202301/31/2023  01/31/2023
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508501/20/202301/31/2023  01/31/2023
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/20/202301/31/2023  01/31/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/18/202211/01/2022  11/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681310/18/202211/01/2022  11/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/18/202211/01/2022  11/01/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/18/202211/01/2022  11/01/2022
Contract DetailSUTTER HEALTH SPECIALTY PHARMACY @ ABSMC2001 DWIGHT WAY STE 2182
BERKELEYCA9470404/12/202207/01/2022  07/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050291AChildDSHSutter Bay Hospitals, dba Sutter Santa Rosa Regional HospitalSSRRH Outpatient Infusion Center - Infusion3883 Airway DriveSanta RosaCAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateChange RequestDunbar, Rachel 340B Analyst Sutter Health 9169523480Dunbar, Rachel L 340B Analyst Sutter Health 916952348012/4/2024 6:14 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request AR9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request CO9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request ID9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request IL9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request IA9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request KY9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request LA9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request MN9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request MS9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request NY9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request NC9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request ND9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request OR9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request TN9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request UT9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request VA9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request WV9/24/2024 10:36 AM
Medicaid BillingNPI: NumberInsertChange Request 17404137989/24/2024 10:36 AM
Medicaid BillingNPI: StateInsertChange Request WI9/24/2024 10:36 AM
DetailsLast Recertification DateUpdateRecertification8/22/2023 3:11:17 PM8/13/2024 8:29:59 AM8/13/2024 8:29 AM
ContactsPrimary ContactUpdateChange RequestCamp, Daniel E. 340B Analyst Sutter Health 6199770058Dunbar, Rachel 340B Analyst Sutter Health 91695234806/25/2024 12:20 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request AL1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request AK1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request AZ1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request CT1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request DE1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request DC1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request FL1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request GA1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request HI1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request KS1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request ME1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request MD1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request MA1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request MI1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request MO1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request MT1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request NE1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request NV1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request NH1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request NJ1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request NM1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request OH1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request OK1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request RI1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request SC1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request SD1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request TX1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request VT1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request WA1/18/2024 11:44 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17404137981/18/2024 11:44 AM
Medicaid BillingNPI: StateInsertGroup Change Request WY1/18/2024 11:44 AM
ContactsPrimary ContactUpdateGroup Change RequestMcLaughlin, Claudine Eva 340B Analyst Sutter Health 5108698299Camp, Daniel E. 340B Analyst Sutter Health 61997700581/10/2024 7:23 AM
DetailsLast Recertification DateUpdateRecertification8/31/2022 12:24:01 PM8/22/2023 3:11:17 PM8/22/2023 3:11 PM
ContactsAuthorizing OfficialUpdateChange RequestPeterson, Dan CEO Sutter Santa Rosa Regional Hospital Sutter Health 7075764201Yu, Henry Chief Financial Officer, West Bay Sutter Health 41560038506/30/2023 1:42 PM
ContactsAuthorizing OfficialUpdateChange RequestPeterson, Dan Chief Executive Officer Sutter Santa Rosa Regional Hospital 7075764564Peterson, Dan CEO Sutter Santa Rosa Regional Hospital Sutter Health 707576420112/16/2022 2:40 PM
ContactsPrimary ContactUpdateChange RequestMcLaughlin, Claudine 340B Coordinator Sutter Health 5108698299McLaughlin, Claudine Eva 340B Analyst Sutter Health 510869829912/16/2022 2:40 PM
DetailsLast Recertification DateUpdateRecertification8/31/2021 2:00:23 PM8/31/2022 12:24:01 PM8/31/2022 12:24 PM
DetailsLast Recertification DateUpdateRecertification9/14/2020 4:58:21 PM8/31/2021 2:00:23 PM8/31/2021 2:00 PM
Medicaid BillingNPI: StateUpdateRecertification CA9/14/2020 4:58 PM
DetailsLast Recertification DateUpdateRecertification8/27/2019 8:12:18 AM9/14/2020 4:58:21 PM9/14/2020 4:58 PM
ContactsAuthorizing OfficialUpdateChange RequestPURVIS, MIKE CHIEF ADMINISTRATIVE OFFICER Sutter Health 7075764203Peterson, Dan Chief Executive Officer Sutter Santa Rosa Regional Hospital 70757645642/12/2020 3:09 PM
DetailsLast Recertification DateUpdateRecertification8/22/2018 12:16:26 PM8/27/2019 8:12:18 AM8/27/2019 8:12 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/22/2018 12:16 PM
Medicaid BillingMedicaid: NumberInsertRecertification HSP40291G8/22/2018 12:16 PM
Medicaid BillingMedicaid: StateInsertRecertification CA8/22/2018 12:16 PM
DetailsLast Recertification DateUpdateRecertification11/8/2017 1:29:57 PM8/22/2018 12:16:26 PM8/22/2018 12:16 PM
ContactsPrimary ContactUpdateRecertificationMinnie, Mark Director Of Pharmacy 4152091485McLaughlin, Claudine 340B Coordinator Sutter Health 510869829911/8/2017 1:29 PM
DetailsLast Recertification DateUpdateRecertification8/22/2016 12:00:00 AM11/8/2017 1:29:57 PM11/8/2017 1:29 PM
DetailsEntity NameUpdateRecertificationSutter Bay Hospitals Sutter Bay Hospitals, dba Sutter Santa Rosa Regional Hospital11/8/2017 1:29 PM
ContactsAuthorizing OfficialUpdate PURVIS, MIKE CHIEF ADMINISTRATIVE OFFICER 7075764203PURVIS, MIKE CHIEF ADMINISTRATIVE OFFICER Sutter Health 707576420311/8/2017 1:18 PM
AddressesMain AddressInsert   30 MARK WEST SPRINGS ROAD SANTA ROSA, CA 954034/11/2017 4:15 PM
AddressesBilling AddressInsert  Sutter Shared Services PO Box 619110 Accounts Payable Roseville, CA 956614/11/2017 4:15 PM
ContactsPrimary ContactUpdate JOHNSON, LAQUOIA PHARMACY MANAGER 7075764344Minnie, Mark Director Of Pharmacy 41520914854/11/2017 4:15 PM
ContactsAuthorizing OfficialUpdate ELLERBE, DANA F. ASSISTANT ADMINISTRATOR 7075764004PURVIS, MIKE CHIEF ADMINISTRATIVE OFFICER 70757642034/11/2017 4:15 PM
ContactsPrimary ContactUpdate BUFFUM, MICHAEL PHARMACY MANAGER 7075764340JOHNSON, LAQUOIA PHARMACY MANAGER 70757643448/22/2016 4:16 PM
DetailsLast Recertification DateUpdate 8/26/2015 12:00:00 AM8/22/2016 12:00:00 AM8/22/2016 4:16 PM
DetailsEntity NameUpdate SUTTER SANTA ROSA REGIONAL HOSPITALSutter Bay Hospitals 3/4/2016 2:45 PM
DetailsEntity SubnameUpdate  dba Sutter Santa Rosa Regional Hospital 3/4/2016 2:45 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/26/2015 4:39 PM
Medicaid BillingNPI: NumberInsert  17404137988/26/2015 4:39 PM
DetailsLast Recertification DateUpdate 9/3/2014 12:00:00 AM8/26/2015 12:00:00 AM8/26/2015 4:39 PM
ContactsPrimary ContactUpdate FORNI, PETE PHARMACY MANAGER 7075764340BUFFUM, MICHAEL PHARMACY MANAGER 70757643408/26/2015 4:29 PM
DetailsEntity NameUpdate SUTTER MEDICAL CENTER OF SANTA ROSASUTTER SANTA ROSA REGIONAL HOSPITAL10/21/2014 4:15 PM
DetailsLast Recertification DateUpdate 8/22/2013 12:00:00 AM9/3/2014 12:00:00 AM9/3/2014 3:31 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/22/2013 12:00:00 AM8/22/2013 6:07 PM
ContactsPrimary ContactUpdate BARTLETT, LAWRENCE REGIONAL PHARMACY DIRECTOR 7075764340FORNI, PETE PHARMACY MANAGER 70757643405/14/2012 8:23 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/14/2012 8:23 AM
Medicaid BillingMedicaid: NumberUpdate PHB418780ZZR00291G2/22/2012 12:24 PM
DetailsComments PublicInsert  2/22/12 UPDATE MEDICAID # FROM PHB418780 2/22/2012 12:24 PM
ContactsAuthorizing OfficialInsert  ELLERBE, DANA F. ASSISTANT ADMINISTRATOR 70757640048/18/2006 1:52 PM
ContactsPrimary ContactInsert  BARTLETT, LAWRENCE REGIONAL PHARMACY DIRECTOR 70757643408/18/2006 1:52 PM
DetailsLast Recertification DateInsert   8/18/2006 1:52 PM
DetailsGrant NumberInsert   8/18/2006 1:52 PM
Details340B IDInsert  DSH0502918/18/2006 1:52 PM
DetailsIs Authorizing Official EHB DataInsert   8/18/2006 1:52 PM
DatesLast Date That 340B Drugs PurchasedInsert   8/18/2006 1:52 PM
DetailsMedicare Provider NumberInsert  0502918/18/2006 1:52 PM
DetailsEntity NameInsert  SUTTER MEDICAL CENTER OF SANTA ROSA8/18/2006 1:52 PM
DetailsProgram CodeInsert  DSH8/18/2006 1:52 PM
DetailsEntity SubnameInsert   8/18/2006 1:52 PM
DatesParticipating Approval DateInsert  6/2/2005 12:00:00 AM8/18/2006 1:52 PM
DetailsStateInsert  Active8/18/2006 1:52 PM
DatesRegistration DateInsert  7/1/2005 12:00:00 AM8/18/2006 1:52 PM
DatesSigned By DateInsert  5/18/2005 12:00:00 AM8/18/2006 1:52 PM
DatesStart DateInsert  7/1/2005 12:00:00 AM8/18/2006 1:52 PM
TerminationsTermination CommentsInsert   8/18/2006 1:52 PM
TerminationsTermination DateInsert   8/18/2006 1:52 PM
TerminationsTermination Effective DateInsert   8/18/2006 1:52 PM
TerminationsTermination ReasonInsert   8/18/2006 1:52 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True7/1/2005 12:00 AM
Medicaid BillingMedicaid: NumberInsert  PHB4187807/1/2005 12:00 AM
Medicaid BillingMedicaid: StateInsert  CA7/1/2005 12:00 AM