Covered Entity Details

DSH050159R VENTURA COUNTY MEDICAL CENTER (Terminated) - information as of 4/25/2025 12:00:24 AM

Main Details

Name

VENTURA COUNTY MEDICAL CENTER

Subdivision Name

Orthopedic Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050159R

Medicare Provider Number

050159

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

9/6/2007

Participating Start Date

1/1/1998

Participating Approval Date

9/6/2007

Last Recertification Date

8/31/2018

Termination Date
Termination Reason

10/1/2019
Site closure

Contacts

Authorizing Official

Ventura County Medical Center
John Fankhauser, Chief Executive Officer
(805) 652-6058

Primary Contact

Ventura County Medical Center
Jason Arimura, Associate Hospital Administrator - Ancillary Services
(805) 652-6759

Addresses

Street Address

300 HILLMONT AVE
Ventura, CA 93003

Billing Address

VCMC Accounts Payable
800 S Victoria Ave; L4610
Ventura, CA 93009

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	ZZT49008F
		1629167457

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	ALL-MED DRUGS	442 N. MOORPARK RD.		THOUSAND OAKS	CA	91360	07/12/2013	10/01/2013	12/15/2018	12/20/2018
Contract Detail	DRG PHARMACY LLC	HUENEME FAMILY PHARMACY	401 N LOMBARD ST STE A	OXNARD	CA	93030-8032	07/12/2013	10/01/2013	12/15/2018	12/20/2018
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 08520	1205 S. OXNARD BLVD	OXNARD	CA	93030	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09683	5900 TELEGRAPH RD.	VENTURA	CA	93003	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09695	551 S. VENTURA RD.	OXNARD	CA	93030	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09151	600 W MAIN ST	SANTA PAULA	CA	93060	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09236	50 N ASHWOOD AVE	VENTURA	CA	93003	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09286	581 W CHANNEL ISLANDS BLVD	PORT HUENEME	CA	93041	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09556	1740 S VICTORIA AVE	VENTURA	CA	93003	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09969	7850 TELEGRAPH RD	VENTURA	CA	93004	10/19/2015	01/01/2016	12/15/2018	12/20/2018
Contract Detail	MEDICAL PLAZA PHARMACY	SCRIPT COMPANY, INC. DBA	1700 N ROSE AVE STE 140	OXNARD	CA	93030	07/12/2013	10/01/2013	10/01/2019	10/01/2019
Contract Detail	MEDICAL PLAZA PHARMACY	SCRIPT COMPANY, INC. DBA	353 CENTRAL AVENUE	FILLMORE	CA	93015	07/16/2014	10/01/2014	12/15/2018	12/20/2018
Contract Detail	MEDICINE SHOPPE	9308 TELEPHONE RD STE B		VENTURA	CA	93004-2680	07/12/2013	10/01/2013	10/01/2019	10/01/2019
Contract Detail	OXNARD DRUG	105 W 5TH ST		OXNARD	CA	93030	07/12/2013	10/01/2013	10/01/2019	10/01/2019
Contract Detail	PALM PHARMACY	254 E HARVARD BLVD.		SANTA PAULA	CA	93060-3372	07/12/2013	10/01/2013	10/01/2019	10/01/2019
Contract Detail	SEENA PHARMACY	BASSO PHARMACY, INC. DBA	3901 LAS POSAS RD STE 101	CAMARILLO	CA	93010-1505	10/16/2014	01/01/2015	10/01/2019	10/01/2019
Contract Detail	SIMI PHARMACY	1357 E LOS ANGELES AVE STE C		SIMI VALLEY	CA	93065-2890	07/12/2013	10/01/2013	10/01/2019	10/01/2019
Contract Detail	THE MEDICINE SHOPPE	2196 SAVIERS RD		OXNARD	CA	93033	07/12/2013	10/01/2013	10/01/2019	10/01/2019
Contract Detail	THE MEDICINE SHOPPE #387	2611 EAST THOMPSON BLVD	UNIT 103	VENTURA	CA	93003	10/16/2014	01/01/2015	10/01/2019	10/01/2019
Contract Detail	VENTURA COUNTY PHARMACY	3350 LOMA VISTA RD		VENTURA	CA	93003-3024	07/14/2017	10/01/2017	10/01/2019	10/01/2019
Contract Detail	WAL-MART PHARMACY 10-2032	2001 NORTH ROSE AVENUE		OXNARD	CA	93036	01/20/2015	04/01/2015	12/15/2018	12/20/2018
Contract Detail	WAL-MART PHARMACY 10-2621	255 COCHRAN STREET		SIMI VALLEY	CA	93065	01/20/2015	04/01/2015	12/15/2018	12/20/2018
Contract Detail	WAL-MART PHARMACY 10-3087	2701 SAVIERS RD		OXNARD	CA	93033	01/20/2015	04/01/2015	12/15/2018	12/20/2018
Contract Detail	WAL-MART PHARMACY 10-5643	421 W ESPLANADE DR		OXNARD	CA	93036	01/20/2015	04/01/2015	12/15/2018	12/20/2018
Contract Detail	WALMART PHARMACY 10-3147	2204 TAPO STREET		SIMI VALLEY	CA	93063	01/20/2015	04/01/2015	12/15/2018	12/20/2018
Contract Detail	WALMART PHARMACY 10-3179	512 NORTH VENTU PARK RD		THOUSAND OAKS	CA	91320	01/20/2015	04/01/2015	12/15/2018	12/20/2018
Contract Detail	WALMART PHARMACY 10-3650	1739 S VICTORIA AVE		VENTURA	CA	93003	01/20/2015	04/01/2015	12/15/2018	12/20/2018
Contract Detail	WALMART PHARMACY 10-5664	275 WEST VENTURA BLVD.		CAMARILLO	CA	93010	01/20/2015	04/01/2015	12/15/2018	12/20/2018

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH050159AA	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Neuroscience Center of Ventura County	3170 Loma Vista Road	Ventura	CA	Terminated
DSH050159AB	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Pediatric Hematology-Oncology Clinic	300 HILLMONT AVE, BLDG #340	Ventura	CA	Active
DSH050159AC	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital - Day Surgery - Surgery Services	825 North 10th St.	Santa Paula	CA	Active
DSH050159AD	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital - Ultrasonography - Imaging Services	825 North 10th St.	Santa Paula	CA	Active
DSH050159AE	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital - MRI - Imaging Services	825 North 10th St.	Santa Paula	CA	Terminated
DSH050159AF	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital - Emergency Services - Emergency Services	825 North 10th St.	Santa Paula	CA	Active
DSH050159AG	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital - Radiology - CAT Scan - Imaging Services	825 North 10th St.	Santa Paula	CA	Active
DSH050159AH	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital - Radiology - Diagnostic - Imaging Services	825 North 10th St.	Santa Paula	CA	Active
DSH050159AJ	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital - Surgery - Surgery Services	825 North 10th St.	Santa Paula	CA	Active
DSH050159D	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Academic Family Medicine Center Clinic	300 HILLMONT AVE, BLDG #340	Ventura	CA	Active
DSH050159E	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Medicine Specialty Center-West	300 HILLMONT AVE, BLDG #340	Ventura	CA	Active
DSH050159F	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Hematology and Oncology Clinic	300 HILLMONT AVE, BLDG #340 #501	Ventura	CA	Active
DSH050159H	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Immunology Clinic	300 HILLMONT AVE, BLDG #340	Ventura	CA	Active
DSH050159I	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Santa Paula Hospital	825 North 10th St.	Santa Paula	CA	Terminated
DSH050159R	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Orthopedic Clinic	300 HILLMONT AVE	Ventura	CA	Terminated
DSH050159U	Child	DSH	Ventura County Medical Center	Ventura County Mental Health	200 Hillmont Ave.	Ventura	CA	Terminated
DSH050159V	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Cardiology Clinic	300 HILLMONT AVE, BLDG #340	Ventura	CA	Active
DSH050159W	Child	DSH	VENTURA COUNTY MEDICAL CENTER	WOMEN'S HEALTH CENTER	3291 LOMA VISTA ROAD	VENTURA	CA	Terminated
DSH050159X	Child	DSH	Ventura County Medical Center	Employee Health Services	800 South Victoria	Ventura	CA	Terminated
DSH050159Y	Child	DSH	VENTURA COUNTY MEDICAL CENTER	Anacapa Surgical Associates/Urology Clinic	300 HILLMONT AVE, BLDG #340	Ventura	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Arimura, Jason Director of Pharmacy Ventura County Medical Center 8056523217	Arimura, Jason Associate Hospital Administrator - Ancillary Services Ventura County Medical Center 8056526759	7/15/2021 7:27 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		7/1/2019 12:00:00 AM	9/4/2019 2:29 PM
Details	State	Update	Recertification	Active	To Be Terminated	9/4/2019 2:29 PM
Terminations	Termination Date	Update	Recertification		10/1/2019 12:00:00 AM	9/4/2019 2:29 PM
Terminations	Termination Effective Date	Update	Recertification		7/1/2019 12:00:00 AM	9/4/2019 2:29 PM
Terminations	Termination Reason	Update	Recertification		Site closure	9/4/2019 2:29 PM
Contacts	Authorizing Official	Update	Change Request	MILSTIEN, KIM CHIEF EXECUTIVE OFFICER VENTURA COUNTY MEDICAL CENTER 8056526058	Fankhauser, John Chief Executive Officer Ventura County Medical Center 8056526058	7/24/2019 7:16 AM
Addresses	Billing Address	Update	Change Request	VCMC ACCOUNTS PAYABLE 2323 KNOLL DRIVE #210 VENTURA, CA 93003	VCMC Accounts Payable 800 S Victoria Ave; L4610 Ventura, CA 93009	12/20/2018 6:29 PM
Details	Last Recertification Date	Update	Recertification	11/7/2017 8:43:27 AM	8/31/2018 1:37:04 PM	8/31/2018 1:37 PM
Contacts	Authorizing Official	Update	Change Request	Kellerhouse, Kathleen Chief of Hospital Operations Ventura County Medical Center 8056526052	MILSTIEN, KIM CHIEF EXECUTIVE OFFICER VENTURA COUNTY MEDICAL CENTER 8056526058	5/31/2018 9:03 AM
Contacts	Primary Contact	Update	Change Request	Flynn, Joseph Pharmacy Operations Supervisor Ventura County Medical Center 8056525758	Arimura, Jason Director of Pharmacy Ventura County Medical Center 8056523217	4/16/2018 2:22 PM
Details	Entity Name	Update	Recertification	Ventura County Medical Center	VENTURA COUNTY MEDICAL CENTER	11/8/2017 12:08 PM
Addresses	Billing Address	Insert	Recertification		VCMC ACCOUNTS PAYABLE 2323 KNOLL DRIVE #210 VENTURA, CA 93003	11/7/2017 8:43 AM
Addresses	Main Address	Update	Recertification	3291 Loma Vista Road Ventura, CA 93003	300 HILLMONT AVE Ventura, CA 93003	11/7/2017 8:43 AM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	11/7/2017 8:43:27 AM	11/7/2017 8:43 AM
Contacts	Authorizing Official	Update		Kellerhouse, Kathleen Chief of Hospital Operations 8056526052	Kellerhouse, Kathleen Chief of Hospital Operations Ventura County Medical Center 8056526052	10/25/2017 4:11 PM
Contacts	Primary Contact	Update		Flynn, Joseph Pharmacy Operations Supervisor 8056525758	Flynn, Joseph Pharmacy Operations Supervisor Ventura County Medical Center 8056525758	10/18/2017 2:40 PM
Contacts	Authorizing Official	Update		LORENZ, PAUL E. DEPUTY DIRECTOR 8056775272	Kellerhouse, Kathleen Chief of Hospital Operations 8056526052	7/14/2017 5:22 PM
Contacts	Primary Contact	Update		Arimura, Jason Director of Pharmacy 8056523217	Flynn, Joseph Pharmacy Operations Supervisor 8056525758	10/28/2016 9:26 AM
Addresses	Main Address	Insert			3291 LOMA VISTA ROAD VENTURA, CA 93003	9/2/2016 9:09 PM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 9:09 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/25/2015 11:45 AM
Details	Last Recertification Date	Update		9/4/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/25/2015 11:45 AM
Contacts	Primary Contact	Update		Tufte, Matthew Chief Hospital Operations - Nursing 8056526567	Arimura, Jason Director of Pharmacy 8056523217	8/25/2015 11:45 AM
Medicaid Billing	NPI: Number	Insert			1629167457	8/3/2015 10:53 AM
Details	Entity Name	Update		VENTURA COUNTY MEDICAL CENTER	Ventura County Medical Center	8/3/2015 10:53 AM
Details	Entity Subname	Update		ORTHOPEDIC CLINIC	Orthopedic Clinic	8/3/2015 10:53 AM
Dates	Participating Approval Date	Update		9/6/2007 12:02:42 PM	9/6/2007 12:00:00 AM	8/3/2015 10:53 AM
Details	Last Recertification Date	Update		8/30/2013 7:19:04 AM	9/4/2014 12:00:00 AM	9/4/2014 6:49 AM
Contacts	Primary Contact	Insert			Tufte, Matthew Chief Hospital Operations - Nursing 8056526567	7/23/2014 3:02 PM
Contacts	Authorizing Official	Insert			LORENZ, PAUL E. DEPUTY DIRECTOR 8056775272	3/17/2014 7:37 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/30/2013 7:19:04 AM	8/30/2013 7:19 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/15/2012 7:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/6/2007 11:47 AM
Medicaid Billing	Medicaid: Number	Insert			ZZT49008F	9/6/2007 11:47 AM
Medicaid Billing	Medicaid: State	Insert			CA	9/6/2007 11:47 AM
Details	Last Recertification Date	Insert				9/6/2007 11:47 AM
Details	Grant Number	Insert				9/6/2007 11:47 AM
Details	340B ID	Insert			DSH050159R	9/6/2007 11:47 AM
Details	Is Authorizing Official EHB Data	Insert				9/6/2007 11:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert				9/6/2007 11:47 AM
Details	Medicare Provider Number	Insert			050159	9/6/2007 11:47 AM
Details	Entity Name	Insert			VENTURA COUNTY MEDICAL CENTER	9/6/2007 11:47 AM
Details	Program Code	Insert			DSH	9/6/2007 11:47 AM
Details	Entity Subname	Insert			ORTHOPEDIC CLINIC	9/6/2007 11:47 AM
Dates	Participating Approval Date	Insert			9/6/2007 12:02:42 PM	9/6/2007 11:47 AM
Details	State	Insert			Active	9/6/2007 11:47 AM
Dates	Registration Date	Insert			9/6/2007 12:00:00 AM	9/6/2007 11:47 AM
Dates	Signed By Date	Insert				9/6/2007 11:47 AM
Dates	Start Date	Insert			1/1/1998 12:00:00 AM	9/6/2007 11:47 AM
Terminations	Termination Comments	Insert				9/6/2007 11:47 AM
Terminations	Termination Date	Insert				9/6/2007 11:47 AM
Terminations	Termination Effective Date	Insert				9/6/2007 11:47 AM
Terminations	Termination Reason	Insert				9/6/2007 11:47 AM