Covered Entity Details

DSH050315A KERN MEDICAL CENTER (Terminated) - information as of 4/24/2025 11:59:37 PM

Main Details

Name

KERN MEDICAL CENTER

Subdivision Name

SAGEBRUSH MEDICAL CLINIC

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050315A

Medicare Provider Number

050315

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/29/2008

Participating Start Date

10/1/1995

Participating Approval Date

4/29/2008

Last Recertification Date

8/13/2024

Termination Date
Termination Reason

10/1/2024
Business decision by the Covered Entity

Contacts

Authorizing Official

Kern Medical Center
Scott Thygerson, Chief Executive Officer
(661) 326-2102

Primary Contact

Kern Medical
Jeffrey Charles Jolliff, Director of Pharmacy
(661) 326-2191

Addresses

Street Address

1111 COLUMBUS STREET
BAKERSFIELD, CA 93305

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
02/14/2012 updated sub-name (was SAGEBRUSH PHARMACY); 3/18/04 CARVE OUT/DELETE MED #PHOE30370	02/14/2012
3/18/04 CARVE OUT/DELETE MED #PHOE30370	04/29/2008

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	HSC30315W	1699859223,1376623538,1427176569,1629081849

Shipping Addresses

Shipping Address 1

SAGEBRUSH MEDICAL PLAZA PHARMACY,
1111 COLUMBUS STREET, SUITE # 2000
BAKERSFIELD, CA 93305

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
DSH050315A	Child	DSH	KERN MEDICAL CENTER	SAGEBRUSH MEDICAL CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Terminated
DSH050315C	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - OBGYN CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315D	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - PEDIATRICS CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315E	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - MEDICINE CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315F	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - COLUMBUS INFUSION CENTER	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315G	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - FAMILY PRACTICE CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315H	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - MEDICINE SPECIALTY CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/5/2022 12:00:00 AM	8/16/2024 8:24 AM
Details	State	Update	Termination Request	Active	To Be Terminated	8/16/2024 8:24 AM
Terminations	Termination Date	Update	Termination Request		10/1/2024 12:00:00 AM	8/16/2024 8:24 AM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2024 12:00:00 AM	8/16/2024 8:24 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	8/16/2024 8:24 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 10:56:31 AM	8/13/2024 10:38:34 AM	8/13/2024 10:38 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 6:51:59 AM	8/16/2023 10:56:31 AM	8/16/2023 10:56 AM
Contacts	Primary Contact	Update	Recertification	Joson, Jeremiah Associate Director of Pharmacy Kern Medical Center 6613265682	Jolliff, Jeffrey Charles Director of Pharmacy Kern Medical 6613262191	8/29/2022 6:51 AM
Details	Last Recertification Date	Update	Recertification	8/27/2021 11:27:32 AM	8/29/2022 6:51:59 AM	8/29/2022 6:51 AM
Contacts	Authorizing Official	Update	AO Change Request	Judd, Russell V Chief Executive Officer Kern Medical Center 6613262102	Thygerson, Scott Chief Executive Officer Kern Medical Center 6613262102	12/8/2021 7:40 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 6:55:01 PM	8/27/2021 11:27:32 AM	8/27/2021 11:27 AM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:55 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:55 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:55 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:55 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 11:50:39 AM	8/18/2020 6:55:01 PM	8/18/2020 6:55 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 11:24:54 AM	8/29/2019 11:50:39 AM	8/29/2019 11:50 AM
Contacts	Authorizing Official	Update	Profile Change Request	Judd, Russell V Chief Executive Officer Kern Medical 6613262102	Judd, Russell V Chief Executive Officer Kern Medical Center 6613262102	4/15/2019 12:49 PM
Contacts	Primary Contact	Update	Profile Change Request	Joson, Jeremiah Associate Director of Pharmacy Kern Medical c 6613265682	Joson, Jeremiah Associate Director of Pharmacy Kern Medical Center 6613265682	4/15/2019 12:27 PM
Contacts	Primary Contact	Update	Profile Change Request	Joson, Jeremiah Associate Director of Pharmacy Kern Medical 6613265682	Joson, Jeremiah Associate Director of Pharmacy Kern Medical c 6613265682	4/15/2019 12:27 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1376623538	10/25/2018 12:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1427176569	10/25/2018 12:39 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1629081849	10/25/2018 12:39 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 7:13:14 AM	8/17/2018 11:24:54 AM	8/17/2018 11:24 AM
Contacts	Authorizing Official	Update	Profile Change Request	Judd, Russell V Chief Executive Officer Kern Medical 6613262101	Judd, Russell V Chief Executive Officer Kern Medical 6613262102	11/29/2017 4:41 PM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/6/2017 7:13:14 AM	11/6/2017 7:13 AM
Contacts	Authorizing Official	Update	AO Change Request	Judd, Russell CEO 6613262095	Judd, Russell V Chief Executive Officer Kern Medical 6613262101	10/30/2017 1:15 PM
Contacts	Primary Contact	Update	Profile Change Request	Joson, Jeremiah Assistant Director of Pharmacy Kern Medical 6613265682	Joson, Jeremiah Associate Director of Pharmacy Kern Medical 6613265682	10/10/2017 2:14 PM
Contacts	Primary Contact	Update		Joson, Jeremiah Assistant Director of Pharmacy 6613265682	Joson, Jeremiah Assistant Director of Pharmacy Kern Medical 6613265682	10/10/2017 1:31 PM
Addresses	Main Address	Insert			1111 COLUMBUS STREET BAKERSFIELD, CA 93305	8/11/2016 4:13 PM
Contacts	Primary Contact	Update		Amos, Aniece Director of Pharmacy 6613265199	Joson, Jeremiah Assistant Director of Pharmacy 6613265682	8/11/2016 4:13 PM
Contacts	Authorizing Official	Update		Judd, Russell Chief Executive Officer 6613262102	Judd, Russell CEO 6613262095	8/11/2016 4:13 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 4:13 PM
Addresses	Shipping Address	Insert			SAGEBRUSH MEDICAL PLAZA PHARMACY, 1111 COLUMBUS STREET, SUITE # 2000 BAKERSFIELD, CA 93305	8/19/2015 3:49 PM
Details	Last Recertification Date	Update		9/10/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/13/2015 3:28 PM
Details	Last Recertification Date	Update		9/6/2013 12:00:00 AM	9/10/2014 12:00:00 AM	9/10/2014 4:37 PM
Contacts	Primary Contact	Update		MARTIN, DARYL SENIOR PHARMACIST 6613262506	Amos, Aniece Director of Pharmacy 6613265199	9/9/2014 7:55 AM
Contacts	Authorizing Official	Update		Hensler, Paul Chief Executive Officer 6613262102	Judd, Russell Chief Executive Officer 6613262102	7/23/2014 3:02 PM
Contacts	Authorizing Official	Update		BAINBRIDGE, ROBERT INTERIM CHIEF FINANCIAL OFFICER 6613262104	Hensler, Paul Chief Executive Officer 6613262102	9/6/2013 5:32 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/6/2013 12:00:00 AM	9/6/2013 5:32 PM
Contacts	Primary Contact	Insert			MARTIN, DARYL SENIOR PHARMACIST 6613262506	9/4/2013 2:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/16/2013 8:22 AM
Medicaid Billing	Medicaid: Number	Insert			HSC30315W	7/16/2013 8:22 AM
Medicaid Billing	Medicaid: State	Insert			CA	7/16/2013 8:22 AM
Medicaid Billing	NPI: Number	Insert			1699859223	7/16/2013 8:22 AM
Contacts	Authorizing Official	Insert			BAINBRIDGE, ROBERT INTERIM CHIEF FINANCIAL OFFICER 6613262104	7/16/2013 8:22 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/22/2012 12:50 PM
Details	Entity Subname	Update		SAGEBRUSH PHARMACY	SAGEBRUSH MEDICAL CLINIC	2/14/2012 1:41 PM
Dates	Participating Approval Date	Update		4/29/2008 1:58:35 PM	4/29/2008 12:00:00 AM	2/14/2012 1:41 PM
Details	Comments Public	Insert			02/14/2012 updated sub-name (was SAGEBRUSH PHARMACY); 3/18/04 CARVE OUT/DELETE MED #PHOE30370	2/14/2012 1:41 PM
Details	Last Recertification Date	Insert				4/29/2008 2:02 PM
Details	Grant Number	Insert				4/29/2008 2:02 PM
Details	340B ID	Insert			DSH050315A	4/29/2008 2:02 PM
Details	Is Authorizing Official EHB Data	Insert				4/29/2008 2:02 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/29/2008 2:02 PM
Details	Medicare Provider Number	Insert			050315	4/29/2008 2:02 PM
Details	Entity Name	Insert			KERN MEDICAL CENTER	4/29/2008 2:02 PM
Details	Program Code	Insert			DSH	4/29/2008 2:02 PM
Details	Entity Subname	Insert			SAGEBRUSH PHARMACY	4/29/2008 2:02 PM
Dates	Participating Approval Date	Insert			4/29/2008 1:58:35 PM	4/29/2008 2:02 PM
Details	State	Insert			Active	4/29/2008 2:02 PM
Dates	Registration Date	Insert			4/29/2008 12:00:00 AM	4/29/2008 2:02 PM
Dates	Signed By Date	Insert				4/29/2008 2:02 PM
Dates	Start Date	Insert			10/1/1995 12:00:00 AM	4/29/2008 2:02 PM
Terminations	Termination Comments	Insert				4/29/2008 2:02 PM
Terminations	Termination Date	Insert				4/29/2008 2:02 PM
Terminations	Termination Effective Date	Insert				4/29/2008 2:02 PM
Terminations	Termination Reason	Insert				4/29/2008 2:02 PM
Details	Comments Public	Insert			3/18/04 CARVE OUT/DELETE MED #PHOE30370	4/29/2008 2:02 PM