| Details | Last Recertification Date | Update | Recertification | 8/16/2023 8:01:53 AM | 8/16/2024 8:12:18 AM | 8/16/2024 8:12 AM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2022 10:12:34 AM | 8/16/2023 8:01:53 AM | 8/16/2023 8:01 AM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2021 7:15:31 AM | 9/7/2022 10:12:34 AM | 9/7/2022 10:12 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2020 12:32:06 PM | 8/27/2021 7:15:31 AM | 8/27/2021 7:15 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 8/17/2020 12:32 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 8/17/2020 12:32 PM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2019 3:28:17 PM | 8/17/2020 12:32:06 PM | 8/17/2020 12:32 PM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 8:35:10 AM | 8/29/2019 3:28:17 PM | 8/29/2019 3:28 PM |
| Contacts | Primary Contact | Update | Change Request | Moser, Jessica
340B Manager
Dignity Health
6024073876 | Bhatti, Usman
Director of Pharmacy
Dignity Health - California Hospital Medical Center
2137425483 | 12/13/2018 11:14 AM |
| Details | Last Recertification Date | Update | Recertification | 11/15/2017 3:29:28 PM | 8/22/2018 8:35:10 AM | 8/22/2018 8:35 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Cheng, Rebecca
VP CFO
Dignity Health
2137425910 | Cheng, Rebecca
VP CFO
Dignity Health
2137425898 | 1/16/2018 10:10 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 11/15/2017 3:29:28 PM | 11/15/2017 3:29 PM |
| Addresses | Shipping Address | Insert | Change Request | | California Hospital Medical Center
1401 South Grand Avenue
Los Angeles, CA 90015 | 10/3/2017 2:07 PM |
| Addresses | Shipping Address | Insert | Change Request | | Safecor Health, LLC
4060 Business Park Drive
Columbus, OH 43204 | 10/3/2017 2:07 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1114081056 | 9/27/2017 1:03 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Cheng, Rebecca
CFO
Dignity Health
2137425910 | Cheng, Rebecca
VP CFO
Dignity Health
2137425910 | 9/27/2017 1:01 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Cheng, Rebecca
CFO
Dignity Health
8185022204 | Cheng, Rebecca
CFO
Dignity Health
2137425910 | 9/27/2017 1:00 PM |
| Contacts | Authorizing Official | Update | | Cheng, Rebecca
CFO
8185022204 | Cheng, Rebecca
CFO
Dignity Health
8185022204 | 9/27/2017 12:54 PM |
| Contacts | Primary Contact | Update | | Moser, Jessica
340B Manager
6024073876 | Moser, Jessica
340B Manager
Dignity Health
6024073876 | 9/25/2017 6:45 PM |
| Addresses | Main Address | Insert | | |
1401 SOUTH GRAND AVENUE
LOS ANGELES, CA 90015 | 8/4/2017 11:20 AM |
| Addresses | Billing Address | Insert | | | Dignity Health
3033 N. 3rd Ave
Phoenix, AZ 85013 | 8/4/2017 11:20 AM |
| Contacts | Primary Contact | Update | | Yi, Kil
Director of Pharmacy
2137425483 | Moser, Jessica
340B Manager
6024073876 | 8/4/2017 11:20 AM |
| Contacts | Authorizing Official | Insert | | | Cheng, Rebecca
CFO
8185022204 | 8/4/2017 11:20 AM |
| Contacts | Primary Contact | Insert | | | Yi, Kil
Director of Pharmacy
2137425483 | 8/23/2016 1:40 PM |
| Details | Last Recertification Date | Update | | 8/17/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/23/2016 1:40 PM |
| Details | Last Recertification Date | Update | | 8/11/2014 12:00:00 AM | 8/17/2015 12:00:00 AM | 8/21/2015 8:03 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/1/2015 1:24 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | HSC30149I | 7/1/2015 1:24 PM |
| Medicaid Billing | Medicaid: State | Insert | | | CA | 7/1/2015 1:24 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1437308913 | 7/1/2015 1:24 PM |
| Details | Last Recertification Date | Update | | 9/10/2013 12:00:00 AM | 8/11/2014 12:00:00 AM | 8/11/2014 10:14 AM |
| Details | Last Recertification Date | Update | | 1/1/2013 12:00:00 AM | 9/10/2013 12:00:00 AM | 9/10/2013 7:41 AM |
| Details | Last Recertification Date | Update | | | 1/1/2013 12:00:00 AM | 12/14/2012 9:32 PM |
| Details | Last Recertification Date | Insert | | | | 1/11/2010 1:43 PM |
| Details | Grant Number | Insert | | | | 1/11/2010 1:43 PM |
| Details | 340B ID | Insert | | | DSH050149 | 1/11/2010 1:43 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 1/11/2010 1:43 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 1/11/2010 1:43 PM |
| Details | Medicare Provider Number | Insert | | | 050149 | 1/11/2010 1:43 PM |
| Details | Entity Name | Insert | | | CALIFORNIA HOSPITAL MEDICAL CENTER | 1/11/2010 1:43 PM |
| Details | Program Code | Insert | | | DSH | 1/11/2010 1:43 PM |
| Details | Entity Subname | Insert | | | | 1/11/2010 1:43 PM |
| Dates | Participating Approval Date | Insert | | | 9/7/2007 12:00:00 AM | 1/11/2010 1:43 PM |
| Details | State | Insert | | | Active | 1/11/2010 1:43 PM |
| Dates | Registration Date | Insert | | | 9/7/2007 12:00:00 AM | 1/11/2010 1:43 PM |
| Dates | Signed By Date | Insert | | | | 1/11/2010 1:43 PM |
| Dates | Start Date | Insert | | | 1/1/2005 12:00:00 AM | 1/11/2010 1:43 PM |
| Terminations | Termination Comments | Insert | | | | 1/11/2010 1:43 PM |
| Terminations | Termination Date | Insert | | | | 1/11/2010 1:43 PM |
| Terminations | Termination Effective Date | Insert | | | | 1/11/2010 1:43 PM |
| Terminations | Termination Reason | Insert | | | | 1/11/2010 1:43 PM |
| Details | Comments Public | Insert | | | 1/5/05 UPDATED ADDR(WAS 1404) | 1/11/2010 1:43 PM |