Covered Entity Details

DSH050026B GROSSMONT HOSPITAL (Active) - information as of 6/4/2025 1:15:13 PM

Main Details

Name

GROSSMONT HOSPITAL

Subdivision Name

SHARP HOME INFUSION SERVICES

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050026B

Medicare Provider Number

050026

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2008

Participating Start Date

10/1/2004

Participating Approval Date

4/15/2008

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Grossmont Hospital
Daniel Kindron, CFO
(619) 740-4743

Primary Contact

Sharp HealthCare
Zephyr T Skeets, 340B Specialist
(858) 499-2148

Addresses

Street Address

3558 RUFFIN ROAD SOUTH
SUITE 101
SAN DIEGO, CA 92123

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
11/18/08 UPDATED ADDR (WAS 9000 WAKARUSA ST BUILDING LA MESA CA 91942)	04/15/2008

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	PHA392720	1457330300,1932485307

Shipping Addresses

Same as Street Address

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
DSH050026B	Child	DSH	GROSSMONT HOSPITAL	SHARP HOME INFUSION SERVICES	3558 RUFFIN ROAD SOUTH	SAN DIEGO	CA	Active
DSH050026C	Child	DSH	GROSSMONT HOSPITAL	Grossmont Medical Terrace - O/P IMAGING	8860 Center Drive	La Mesa	CA	Active
DSH050026D	Child	DSH	GROSSMONT HOSPITAL	Grossmont Medical Terrace - O/P Infusion Clinic	8860 Center Drive	La Mesa	CA	Active
DSH050026E	Child	DSH	GROSSMONT HOSPITAL	Sharp Home Infusion - Specialty Services	3558 RUFFIN ROAD SOUTH	San Diego	CA	Terminated
DSH050026F	Child	DSH	GROSSMONT HOSPITAL	O/P Surgery Center	5525 Grossmont Center Drive	La Mesa	CA	Active
DSH050026G	Child	DSH	GROSSMONT HOSPITAL	Brier Patch Outpatient Rehabilitation Services - Diabetes Clinic	9000 Wakarusa Street	La Mesa	CA	Active
DSH050026H	Child	DSH	GROSSMONT HOSPITAL	Brier Patch Outpatient Rehabilitation Services - Occupational Clinic	9000 Wakarusa Street	La Mesa	CA	Active
DSH050026J	Child	DSH	GROSSMONT HOSPITAL	Brier Patch Outpatient Rehabilitation Services - Physical Therapy Clinic	9000 Wakarusa Street	La Mesa	CA	Active
DSH050026K	Child	DSH	GROSSMONT HOSPITAL	Hospice Administration	4000 Ruffin Road	San Diego	CA	Active
DSH050026L	Child	DSH	GROSSMONT HOSPITAL	LakeView Hospice Residence	9472 Loren Dr	La Mesa	CA	Active
DSH050026M	Child	DSH	GROSSMONT HOSPITAL	ParkView Hospice	5788 Lyden Way	San Diego	CA	Active
DSH050026N	Child	DSH	GROSSMONT HOSPITAL	BonitaView Hospice	3850 Valley Vista Rd	Bonita	CA	Active
DSH050026P	Child	DSH	GROSSMONT HOSPITAL	Care Clinic - Care Clinic	8851 Center Dr.	La Mesa	CA	Active
DSH050026Q	Child	DSH	GROSSMONT HOSPITAL	Prenatal Ultrasound - Ultrasound	8851 Center Dr.	La Mesa	CA	Active
DSH050026R	Child	DSH	GROSSMONT HOSPITAL	Maternal Fetal - Maternal Fetal Care	8851 Center Dr.	La Mesa	CA	Active
DSH050026S	Child	DSH	GROSSMONT HOSPITAL	Perinatal Clinic - Perinatal care	8851 Center Dr.	La Mesa	CA	Active
DSH050026T	Child	DSH	GROSSMONT HOSPITAL	Burr Clinic	5525 Grossmont Center Dr.	La Mesa	CA	Active
DSH050026U	Child	DSH	GROSSMONT HOSPITAL	SGH O/P Specialty Clinic - Stroke Follow up	8851 Center Dr.	La Mesa	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/1/2023 6:22:00 PM	9/3/2024 4:35:31 PM	9/3/2024 4:35 PM
Addresses	Main Address	Update	Recertification	3558 RUFFIN ROAD SOUTH SUITE 100 SAN DIEGO, CA 92123	3558 RUFFIN ROAD SOUTH SUITE 101 SAN DIEGO, CA 92123	9/1/2023 6:22 PM
Contacts	Primary Contact	Update	Recertification	Sachs, Susan System Pharmacy Manager Sharp HealthCare 8584994220	Skeets, Zephyr T 340B Specialist Sharp HealthCare 8584992148	9/1/2023 6:22 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 4:46:08 PM	9/1/2023 6:22:00 PM	9/1/2023 6:22 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:39:57 PM	9/7/2022 4:46:08 PM	9/7/2022 4:46 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 6:32:09 PM	8/23/2021 2:39:57 PM	8/23/2021 2:39 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1457330300	8/19/2020 6:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/19/2020 6:32 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932485307	8/19/2020 6:32 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/19/2020 6:32 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1457330300 ( )		8/19/2020 6:32 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1932485307 ( )		8/19/2020 6:32 PM
Details	Last Recertification Date	Update	Recertification	9/12/2019 12:40:48 PM	8/19/2020 6:32:09 PM	8/19/2020 6:32 PM
Contacts	Primary Contact	Update	Change Request	Flores, Besher 340B Program Specialist Sharp Healthcare 8584994678	Sachs, Susan System Pharmacy Manager Sharp HealthCare 8584994220	8/13/2020 8:42 AM
Details	Last Recertification Date	Update	Recertification	9/6/2018 4:18:27 PM	9/12/2019 12:40:48 PM	9/12/2019 12:40 PM
Details	Last Recertification Date	Update	Recertification	11/17/2017 3:23:26 PM	9/6/2018 4:18:27 PM	9/6/2018 4:18 PM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	11/17/2017 3:23:26 PM	11/17/2017 3:23 PM
Contacts	Authorizing Official	Update		Kindron, Daniel CFO 6197404743	Kindron, Daniel CFO Grossmont Hospital 6197404743	10/5/2017 11:24 AM
Contacts	Primary Contact	Update		Flores, Besher 340B Program Specialist 8584994678	Flores, Besher 340B Program Specialist Sharp Healthcare 8584994678	10/5/2017 11:05 AM
Contacts	Authorizing Official	Insert			Kindron, Daniel CFO 6197404743	8/11/2017 10:58 AM
Contacts	Primary Contact	Update		Jajou, Besher 340B Program Specialist 8584994678	Flores, Besher 340B Program Specialist 8584994678	5/5/2017 11:53 AM
Addresses	Main Address	Insert			3558 RUFFIN ROAD SOUTH SUITE 100 SAN DIEGO, CA 92123	5/3/2017 11:45 AM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 1:20 PM
Medicaid Billing	NPI: Number	Insert			1457330300	5/19/2016 11:17 PM
Medicaid Billing	NPI: Number	Insert			1932485307	5/19/2016 11:17 PM
Details	Last Recertification Date	Update		9/4/2014 12:00:00 AM	8/17/2015 12:00:00 AM	8/17/2015 1:01 PM
Details	Last Recertification Date	Update		9/5/2013 12:00:00 AM	9/4/2014 12:00:00 AM	9/4/2014 9:11 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	3/21/2014 10:41 PM
Medicaid Billing	Medicaid: Number	Insert			PHA392720	3/21/2014 10:41 PM
Medicaid Billing	Medicaid: State	Insert			CA	3/21/2014 10:41 PM
Contacts	Primary Contact	Insert			Jajou, Besher 340B Program Specialist 8584994678	9/25/2013 2:29 PM
Details	Last Recertification Date	Update		9/5/2013 6:30:09 AM	9/5/2013 12:00:00 AM	9/24/2013 12:27 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/5/2013 6:30:09 AM	9/5/2013 6:30 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/1/2012 7:31 AM
Details	Last Recertification Date	Insert				4/15/2008 3:51 PM
Details	Grant Number	Insert				4/15/2008 3:51 PM
Details	340B ID	Insert			DSH050026B	4/15/2008 3:51 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2008 3:51 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2008 3:51 PM
Details	Medicare Provider Number	Insert			050026	4/15/2008 3:51 PM
Details	Entity Name	Insert			GROSSMONT HOSPITAL	4/15/2008 3:51 PM
Details	Program Code	Insert			DSH	4/15/2008 3:51 PM
Details	Entity Subname	Insert			SHARP HOME INFUSION SERVICES	4/15/2008 3:51 PM
Dates	Participating Approval Date	Insert			4/15/2008 12:00:00 AM	4/15/2008 3:51 PM
Details	State	Insert			Active	4/15/2008 3:51 PM
Dates	Registration Date	Insert			4/15/2008 12:00:00 AM	4/15/2008 3:51 PM
Dates	Signed By Date	Insert				4/15/2008 3:51 PM
Dates	Start Date	Insert			10/1/2004 12:00:00 AM	4/15/2008 3:51 PM
Terminations	Termination Comments	Insert				4/15/2008 3:51 PM
Terminations	Termination Date	Insert				4/15/2008 3:51 PM
Terminations	Termination Effective Date	Insert				4/15/2008 3:51 PM
Terminations	Termination Reason	Insert				4/15/2008 3:51 PM
Details	Comments Public	Insert			11/18/08 UPDATED ADDR (WAS 9000 WAKARUSA ST BUILDING LA MESA CA 91942)	4/15/2008 3:51 PM