Covered Entity Details

DSH050110 LOMPOC HEALTHCARE DISTRICT (Active) - information as of 4/24/2025 11:59:20 PM

Main Details

Name

LOMPOC HEALTHCARE DISTRICT

Subdivision Name

dba Lompoc Valley Medical Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050110

Medicare Provider Number

050110

Additional Details

Current Program Status

Active

Registration Date

11/28/2006

Participating Start Date

1/1/2007

Participating Approval Date

11/28/2006

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

Lompoc Valley Medical Center
Yvette Cope, Chief Executive Officer
(805) 737-3301

Primary Contact

Lompoc Valley Medical Center
Logan Abney, Lead Clinical Pharmacist, 340B Coordinator
(805) 737-3337

Addresses

Street Address

1515 EAST OCEAN AVENUE
LOMPOC, CA 93436

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
8/17/10 PHYS ADDR CHANGE (WAS 508 EAST HICKORY AVENUE) - 0/08 - ADJ% GREATER THAN 11.75	08/18/2010

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	ZZT30110F,PHB218840,ZZT40110F	1194711952,1376539130

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	10/05/2020	01/01/2021		01/01/2021
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	10/05/2020	01/01/2021		01/01/2021
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/05/2020	01/01/2021		01/01/2021
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	10/05/2020	01/01/2021		01/01/2021
Contract Detail	THE VONS COMPANIES INC	VONS PHARMACY #1738	729 NORTH H STREET	LOMPOC	CA	93436	05/07/2012	05/07/2012	05/11/2021	05/11/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/17/2017	10/01/2017	12/26/2023	03/19/2024
Contract Detail	WAL-MART PHARMACY 10-1989	701 WEST CENTRAL AVE		LOMPOC	CA	93436	05/07/2012	05/07/2012	12/26/2023	03/19/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/17/2017	10/01/2017	12/26/2023	03/19/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/18/2023	04/01/2023	12/26/2023	03/19/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH050110A	Child	DSH	LOMPOC HEALTHCARE DISTRICT	LOMPOC HEALTH CARE DISTRICT - LOMPOC VALLEY MEDICAL CENTER ONCOLOGY-HEMATOLOGY SERVICES	1213 E OCEAN AVE STE 102	LOMPOC	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 2:54:56 PM	9/9/2024 11:37:09 AM	9/9/2024 11:37 AM
Contacts	Authorizing Official	Update	AO Change Request	Popkin, Steve Chief Executive Officer Lompoc Valley Medical Center 8057373301	Cope, Yvette Chief Executive Officer Lompoc Valley Medical Center 8057373301	8/21/2024 6:43 AM
Contacts	Primary Contact	Update	Recertification	Signorelli, Chad Lead Clinical Pharmacist, 340B Coordinator Lompoc Valley Medical Center 8057373337	Abney, Logan Lead Clinical Pharmacist, 340B Coordinator Lompoc Valley Medical Center 8057373337	8/15/2023 2:54 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 2:53:28 PM	8/15/2023 2:54:56 PM	8/15/2023 2:54 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 4:15:46 PM	8/31/2022 2:53:28 PM	8/31/2022 2:53 PM
Details	Last Recertification Date	Update	Recertification	8/20/2020 4:00:56 PM	8/16/2021 4:15:46 PM	8/16/2021 4:15 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/20/2020 4:00 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/20/2020 4:00 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 2:27:51 PM	8/20/2020 4:00:56 PM	8/20/2020 4:00 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 8:21:45 AM	9/4/2019 2:27:51 PM	9/4/2019 2:27 PM
Contacts	Authorizing Official	Update	Change Request	RAGGIO, JAMES J. Chief Executive Officer Lompoc Valley Medical Center 8057373301	Popkin, Steve Chief Executive Officer Lompoc Valley Medical Center 8057373301	3/7/2019 1:25 PM
Details	Last Recertification Date	Update	Recertification	11/8/2017 12:07:03 PM	8/22/2018 8:21:45 AM	8/22/2018 8:21 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	ZZT05256G (CA)		5/23/2018 11:51 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1467554873 ( )		5/23/2018 11:51 AM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/8/2017 12:07:03 PM	11/8/2017 12:07 PM
Contacts	Authorizing Official	Update		RAGGIO, JAMES J. Chief Executive Officer 8057373301	RAGGIO, JAMES J. Chief Executive Officer Lompoc Valley Medical Center 8057373301	10/25/2017 5:04 PM
Contacts	Primary Contact	Update	Profile Change Request	Signorelli, Chad Director, Pharmacy Services Lompoc Valley Medical Center 8057373337	Signorelli, Chad Lead Clinical Pharmacist, 340B Coordinator Lompoc Valley Medical Center 8057373337	10/18/2017 12:16 PM
Contacts	Primary Contact	Update		Signorelli, Chad Director, Pharmacy Services 8057373337	Signorelli, Chad Director, Pharmacy Services Lompoc Valley Medical Center 8057373337	10/10/2017 11:37 AM
Contacts	Authorizing Official	Update		RAGGIO, JAMES J. CEO 8057373301	RAGGIO, JAMES J. Chief Executive Officer 8057373301	7/17/2017 2:20 PM
Addresses	Main Address	Insert			1515 EAST OCEAN AVENUE LOMPOC, CA 93436	8/10/2016 2:26 PM
Contacts	Primary Contact	Update		Signorelli, Chad Director, Pharmacy Services 8057373337	Signorelli, Chad Director, Pharmacy Services 8057373337	8/10/2016 2:26 PM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 2:26 PM
Details	Entity Subname	Update			dba Lompoc Valley Medical Center	8/10/2016 2:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: Number	Insert			ZZT30110F	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: State	Insert			CA	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: Number	Insert			ZZT05256G	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: State	Insert			CA	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: Number	Insert			PHB218840	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: State	Insert			CA	8/7/2015 2:00 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/7/2015 2:00 PM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 2:00 PM
Contacts	Primary Contact	Update		BUCH, NAISHADH D. Chief Operations Officer & Director, Pharmacy Services 8057373337	Signorelli, Chad Director, Pharmacy Services 8057373337	8/7/2014 7:44 AM
Details	Last Recertification Date	Update		8/30/2013 12:00:00 AM	8/7/2014 12:00:00 AM	8/7/2014 7:44 AM
Contacts	Primary Contact	Update		BUCH, NAISHADH D. DIRECTOR, PHARMACY SERVICE 8057373337	BUCH, NAISHADH D. Chief Operations Officer & Director, Pharmacy Services 8057373337	7/3/2014 4:20 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/30/2013 12:00:00 AM	8/30/2013 12:03 PM
Medicaid Billing	NPI: Number	Insert			1194711952	5/14/2012 8:18 AM
Medicaid Billing	NPI: Number	Insert			1376539130	5/14/2012 8:18 AM
Medicaid Billing	NPI: Number	Insert			1467554873	5/14/2012 8:18 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 8:18 AM
Contacts	Authorizing Official	Insert			RAGGIO, JAMES J. CEO 8057373301	8/18/2010 1:13 PM
Contacts	Primary Contact	Insert			BUCH, NAISHADH D. DIRECTOR, PHARMACY SERVICE 8057373337	8/18/2010 1:13 PM
Details	Last Recertification Date	Insert				8/18/2010 1:13 PM
Details	Grant Number	Insert				8/18/2010 1:13 PM
Details	340B ID	Insert			DSH050110	8/18/2010 1:13 PM
Details	Is Authorizing Official EHB Data	Insert				8/18/2010 1:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/18/2010 1:13 PM
Details	Medicare Provider Number	Insert			050110	8/18/2010 1:13 PM
Details	Entity Name	Insert			LOMPOC HEALTHCARE DISTRICT	8/18/2010 1:13 PM
Details	Program Code	Insert			DSH	8/18/2010 1:13 PM
Details	Entity Subname	Insert				8/18/2010 1:13 PM
Dates	Participating Approval Date	Insert			11/28/2006 12:00:00 AM	8/18/2010 1:13 PM
Details	State	Insert			Active	8/18/2010 1:13 PM
Dates	Registration Date	Insert			11/28/2006 12:00:00 AM	8/18/2010 1:13 PM
Dates	Signed By Date	Insert			11/28/2006 12:00:00 AM	8/18/2010 1:13 PM
Dates	Start Date	Insert			1/1/2007 12:00:00 AM	8/18/2010 1:13 PM
Terminations	Termination Comments	Insert				8/18/2010 1:13 PM
Terminations	Termination Date	Insert				8/18/2010 1:13 PM
Terminations	Termination Effective Date	Insert				8/18/2010 1:13 PM
Terminations	Termination Reason	Insert				8/18/2010 1:13 PM
Details	Comments Public	Insert			8/17/10 PHYS ADDR CHANGE (WAS 508 EAST HICKORY AVENUE) - 0/08 - ADJ% GREATER THAN 11.75	8/18/2010 1:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	11/28/2006 1:02 PM
Medicaid Billing	Medicaid: Number	Insert			ZZT40110F	11/28/2006 1:02 PM
Medicaid Billing	Medicaid: State	Insert			CA	11/28/2006 1:02 PM