Covered Entity Details

DSH050045B EL CENTRO REGIONAL MEDICAL CENTER (Active) - information as of 4/25/2025 6:32:02 PM

Main Details

Name

EL CENTRO REGIONAL MEDICAL CENTER

Subdivision Name

Calexico Outpatient Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050045B

Medicare Provider Number

050045

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/14/2013

Participating Start Date

4/1/2013

Participating Approval Date

3/11/2013

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

ECRMC
David Momberg, CFO
(858) 208-7724

Primary Contact

EL CENTRO REGIONAL MEDICAL CENTER
Nghiem Ngoc Linh, pharmacist
(760) 339-7180

Addresses

Street Address

495 Birch Street
Calexico, CA 92231

Billing Address
Same as Street Address

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	RHM18536F	1598840258

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
DSH050045A	Child	DSH	EL CENTRO REGIONAL MEDICAL CENTER	El Centro Regional Medical Center Outpatient Clinic	385 West Main Street	El Centro	CA	Active
DSH050045B	Child	DSH	EL CENTRO REGIONAL MEDICAL CENTER	Calexico Outpatient Center	495 Birch Street	Calexico	CA	Active
DSH050045C	Child	DSH	EL CENTRO REGIONAL MEDICAL CENTER	Imperial Valley Wound Healing Center	1271 Ross Avenue, Suite C	El Centro	CA	Active
DSH050045D	Child	DSH	EL CENTRO REGIONAL MEDICAL CENTER	ECRMC Oncology, Hematology & Infusion Center	1271 Ross Avenue	El Centro	CA	Active
DSH050045E	Child	DSH	EL CENTRO REGIONAL MEDICAL CENTER	ECRMC Specialty Health Center - Specialty Services	1271 Ross Avenue	El Centro	CA	Active
DSH050045F	Child	DSH	EL CENTRO REGIONAL MEDICAL CENTER	Multispecialty - Women's Health	1415 Ross Ave.	El Centro	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	PC Change Request	Duong, Vu Pharmacy Director El Centro Regional Medical Center 7603397180	Linh, Nghiem Ngoc pharmacist EL CENTRO REGIONAL MEDICAL CENTER 7603397180	3/18/2025 12:56 PM
Contacts	Primary Contact	Update	PC Change Request	BALOG, BRUCE PHARMACIST IN CHARGE El Centro Regional Medical Center 7603397180	Duong, Vu Pharmacy Director El Centro Regional Medical Center 7603397180	10/28/2024 12:10 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 6:50:17 PM	8/12/2024 6:56:41 PM	8/12/2024 6:56 PM
Details	Last Recertification Date	Update	Recertification	9/2/2022 4:57:14 PM	8/22/2023 6:50:17 PM	8/22/2023 6:50 PM
Contacts	Authorizing Official	Update	AO Change Request	Valdes, Lenin Assoc. Administrator of Finance El Centro Regional Medical Center 7603397124	Momberg, David CFO ECRMC 8582087724	8/2/2023 12:53 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 1:18:36 PM	9/2/2022 4:57:14 PM	9/2/2022 4:57 PM
Details	Last Recertification Date	Update	Recertification	8/18/2020 5:37:58 PM	8/18/2021 1:18:36 PM	8/18/2021 1:18 PM
Contacts	Authorizing Official	Update	AO Change Request	Hendry, Alec Austin Associate Administrator of Finance El Centro Regional Medical Center 7603397136	Valdes, Lenin Assoc. Administrator of Finance El Centro Regional Medical Center 7603397124	8/3/2021 1:59 PM
Contacts	Authorizing Official	Update	AO Change Request	Kennerson, Cathy Chief Strategic Officer El Centro Regional Medical Center 7603397107	Hendry, Alec Austin Associate Administrator of Finance El Centro Regional Medical Center 7603397136	2/9/2021 8:34 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1598840258	8/18/2020 5:37 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/18/2020 5:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1598840258 ( )		8/18/2020 5:37 PM
Details	Last Recertification Date	Update	Recertification	9/3/2019 4:10:47 PM	8/18/2020 5:37:58 PM	8/18/2020 5:37 PM
Details	Last Recertification Date	Update	Recertification	9/3/2018 4:32:27 PM	9/3/2019 4:10:47 PM	9/3/2019 4:10 PM
Contacts	Authorizing Official	Update	AO Change Request	SALCIDO, TYLER Assistant CFO El Centro Regional Medical Center 7603397264	Kennerson, Cathy Chief Strategic Officer El Centro Regional Medical Center 7603397107	9/27/2018 7:35 AM
Details	Last Recertification Date	Update	Recertification	11/14/2017 11:20:51 AM	9/3/2018 4:32:27 PM	9/3/2018 4:32 PM
Contacts	Authorizing Official	Update	Profile Change Request	SALCIDO, TYLER INTERIM CFO El Centro Regional Medical Center 7603397264	SALCIDO, TYLER Assistant CFO El Centro Regional Medical Center 7603397264	11/16/2017 5:47 PM
Contacts	Primary Contact	Insert	Recertification		BALOG, BRUCE PHARMACIST IN CHARGE El Centro Regional Medical Center 7603397180	11/14/2017 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/14/2017 11:20:51 AM	11/14/2017 11:20 AM
Contacts	Authorizing Official	Update		SALCIDO, TYLER INTERIM CFO 7603397264	SALCIDO, TYLER INTERIM CFO El Centro Regional Medical Center 7603397264	9/29/2017 11:01 AM
Contacts	Signed By	Insert			WELLS, ALEX CFO 7603703774	8/2/2017 10:43 AM
Contacts	Authorizing Official	Insert			SALCIDO, TYLER INTERIM CFO 7603397264	6/15/2017 10:53 AM
Addresses	Main Address	Insert			495 Birch Street Calexico, CA 92231	6/15/2017 10:52 AM
Details	Last Recertification Date	Update		8/28/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 5:39 PM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/28/2015 12:00:00 AM	8/28/2015 2:25 PM
Details	Last Recertification Date	Update		9/4/2013 7:13:51 AM	8/20/2014 12:00:00 AM	8/20/2014 12:03 PM
Details	Last Recertification Date	Update			9/4/2013 7:13:51 AM	9/4/2013 7:13 AM
Details	Entity Subname	Update		CLX Health Center	Calexico Outpatient Center	7/12/2013 3:03 PM
Details	340B ID	Update		ISJMDSH050045B	DSH050045B	3/11/2013 4:07 PM
Dates	Participating Approval Date	Update			3/11/2013 12:00:00 AM	3/11/2013 4:07 PM
Details	State	Update		Pending	Active	3/11/2013 4:07 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	3/11/2013 4:07 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISJMDSH050045B	3/4/2013 10:00 AM
Details	Entity Subname	Update			CLX Health Center	3/4/2013 10:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/14/2013 3:26 PM
Medicaid Billing	Medicaid: Number	Insert			RHM18536F	1/14/2013 3:26 PM
Medicaid Billing	Medicaid: State	Insert			CA	1/14/2013 3:26 PM
Medicaid Billing	NPI: Number	Insert			1598840258	1/14/2013 3:26 PM
Details	Last Recertification Date	Insert				1/14/2013 3:26 PM
Details	Grant Number	Insert				1/14/2013 3:26 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/14/2013 3:26 PM
Details	Is Authorizing Official EHB Data	Insert				1/14/2013 3:26 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2013 3:26 PM
Details	Medicare Provider Number	Insert			050045	1/14/2013 3:26 PM
Details	Entity Name	Insert			EL CENTRO REGIONAL MEDICAL CENTER	1/14/2013 3:26 PM
Details	Program Code	Insert			DSH	1/14/2013 3:26 PM
Details	Entity Subname	Insert				1/14/2013 3:26 PM
Dates	Participating Approval Date	Insert				1/14/2013 3:26 PM
Details	State	Insert			Pending	1/14/2013 3:26 PM
Dates	Registration Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 3:26 PM
Dates	Signed By Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 3:26 PM
Dates	Start Date	Insert				1/14/2013 3:26 PM
Terminations	Termination Comments	Insert				1/14/2013 3:26 PM
Terminations	Termination Date	Insert				1/14/2013 3:26 PM
Terminations	Termination Effective Date	Insert				1/14/2013 3:26 PM
Terminations	Termination Reason	Insert				1/14/2013 3:26 PM