Covered Entity Details

DSH050455A Adventist Health Bakersfield (Active) - information as of 5/9/2025 10:47:01 PM

Main Details

Name

Adventist Health Bakersfield

Subdivision Name

Quest Imaging

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050455A

Medicare Provider Number

050455

Outpatient Facility Provider Number

050455

Additional Details

Current Program Status

Active

Registration Date

7/15/2013

Participating Start Date

10/1/2013

Participating Approval Date

9/13/2013

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Adventist Health Bakersfield
Jennifer Lavers, Chief Operating Officer
(661) 713-5431

Primary Contact

Adventist Health Bakersfield
Zachary Wesley-Keith Glover, 340b Program Compliance Analyst
(661) 869-6280 Ext: 2581

Addresses

Street Address

9602 Stockdale Avenue
Bakersfield, CA 93311

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	HSC30455F,ZZT30455F,ZZT40455F	1538157508

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
DSH050455A	Child	DSH	Adventist Health Bakersfield	Quest Imaging	9602 Stockdale Avenue	Bakersfield	CA	Active
DSH050455B	Child	DSH	Adventist Health Bakersfield	Outpatient Burn Center	2819 H Street	Bakersfield	CA	Terminated
DSH050455C	Child	DSH	Adventist Health Bakersfield	OUT-PATIENT SURGERY CENTER	2620 CHESTER AVE	BAKERSFIELD	CA	Terminated
DSH050455D	Child	DSH	Adventist Health Bakersfield	Wellness Resource Center	1524 27th Street	Bakersfield	CA	Active
DSH050455E	Child	DSH	Adventist Health Bakersfield	AIS CANCER CENTER AT SAN JOAQUIN CO / Radiation Oncology	2620 CHESTER AVE	BAKERSFIELD	CA	Active
DSH050455F	Child	DSH	Adventist Health Bakersfield	AIS Cancer Center / Medical Oncology	2620 Chester Avenue	Bakersfield	CA	Active
DSH050455G	Child	DSH	Adventist Health Bakersfield	AIS Breast Center / Radiology-Therapeutic	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455H	Child	DSH	Adventist Health Bakersfield	Quest Chester - Diagnostic Imaging	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455J	Child	DSH	Adventist Health Bakersfield	Quest Chester - Mammography	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455K	Child	DSH	Adventist Health Bakersfield	Quest Chester - PET	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455L	Child	DSH	Adventist Health Bakersfield	Quest Chester - Nuclear Medicine	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455M	Child	DSH	Adventist Health Bakersfield	Quest Chester - MRI	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455N	Child	DSH	Adventist Health Bakersfield	Quest Chester - Ultrasound	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455P	Child	DSH	Adventist Health Bakersfield	Quest Chester - CT	2700 Chester Avenue	Bakersfield	CA	Active
DSH050455Q	Child	DSH	Adventist Health Bakersfield	Quest Chester - DEXA	2700 Chester Avenue	Bakersfield	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 5:58:26 PM	9/3/2024 4:06:09 PM	9/3/2024 4:06 PM
Contacts	Authorizing Official	Update	AO Change Request	Cox, Shane H Finance Officer Adventist Health 6618696180	Lavers, Jennifer Chief Operating Officer Adventist Health Bakersfield 6617135431	8/18/2024 9:24 AM
Contacts	Primary Contact	Update	Change Request	Bhakta, Dixit D Director of Pharmacy Adventist Health Bakersfield 6618633289	Glover, Zachary Wesley-Keith 340b Program Compliance Analyst Adventist Health Bakersfield 6618696280-2581	9/29/2023 1:32 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 6:28:44 PM	8/21/2023 5:58:26 PM	8/21/2023 5:58 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 5:04:36 PM	9/8/2022 6:28:44 PM	9/8/2022 6:28 PM
Contacts	Primary Contact	Update	Profile Change Request	Bhakta, Dixit D Director of Pharmacy Adventist Health Bakersfield 6618696289	Bhakta, Dixit D Director of Pharmacy Adventist Health Bakersfield 6618633289	10/15/2021 4:45 PM
Details	Last Recertification Date	Update	Recertification	9/14/2020 6:44:57 AM	9/7/2021 5:04:36 PM	9/7/2021 5:04 PM
Contacts	Primary Contact	Update	Change Request	Gonzales, Jerry Frank Director of Pharmacy Adventist Health Bakersfield 6618696289	Bhakta, Dixit D Director of Pharmacy Adventist Health Bakersfield 6618696289	4/12/2021 12:50 PM
Contacts	Authorizing Official	Update	AO Change Request	Chen, Steven G CHIEF FINANCIAL OFFICER Adventist Health Bakersfield 6618696183	Cox, Shane H Finance Officer Adventist Health 6618696180	3/30/2021 3:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:44 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		ZZT30455F	9/14/2020 6:44 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	9/14/2020 6:44 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 6:44 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		ZZT40455F	9/14/2020 6:44 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	9/14/2020 6:44 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1538157508 ( )		9/14/2020 6:44 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1538157508	9/14/2020 6:44 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/14/2020 6:44 AM
Contacts	Primary Contact	Update	Recertification	Gonzales, Adrian Director of Pharmacy San Joaquin Community Hospital 6618696289	Gonzales, Jerry Frank Director of Pharmacy Adventist Health Bakersfield 6618696289	9/14/2020 6:44 AM
Details	Last Recertification Date	Update	Recertification	8/21/2019 2:27:58 PM	9/14/2020 6:44:57 AM	9/14/2020 6:44 AM
Details	Last Recertification Date	Update	Recertification	8/29/2018 7:58:00 PM	8/21/2019 2:27:58 PM	8/21/2019 2:27 PM
Details	Last Recertification Date	Update	Recertification	12/4/2017 4:08:17 PM	8/29/2018 7:58:00 PM	8/29/2018 7:58 PM
Details	Entity Name	Update	Recertification	San Joaquin Community Hospital	Adventist Health Bakersfield	12/4/2017 4:36 PM
Details	Last Recertification Date	Update	Recertification	10/26/2017 8:50:25 AM	12/4/2017 4:08:17 PM	12/4/2017 4:08 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	10/26/2017 8:50:25 AM	10/26/2017 8:50 AM
Contacts	Primary Contact	Update	Recertification	Gonzales, Adrian Director of Pharmacy 6618696289	Gonzales, Adrian Director of Pharmacy San Joaquin Community Hospital 6618696289	10/26/2017 8:45 AM
Contacts	Authorizing Official	Update	Profile Change Request	Chen, Steve CHIEF FINANCIAL OFFICER Adventist Health Bakersfield 6618696183	Chen, Steven G CHIEF FINANCIAL OFFICER Adventist Health Bakersfield 6618696183	9/26/2017 11:22 AM
Contacts	Authorizing Official	Update		Chen, Steve CHIEF FINANCIAL OFFICER 6618696183	Chen, Steve CHIEF FINANCIAL OFFICER Adventist Health Bakersfield 6618696183	9/26/2017 11:17 AM
Contacts	Authorizing Official	Update		Briggs, Sharlet CEO 6618696180	Chen, Steve CHIEF FINANCIAL OFFICER 6618696183	7/17/2017 6:55 PM
Contacts	Primary Contact	Update		Mookie, Mooler Pharmacy Purchaser 6618696280	Gonzales, Adrian Director of Pharmacy 6618696289	5/18/2017 12:43 PM
Contacts	Signed By	Insert			Soper, Brent W. Chief Financial Officer 6618696180	5/18/2017 12:42 PM
Addresses	Main Address	Insert			9602 Stockdale Avenue Bakersfield, CA 93311	5/18/2017 12:41 PM
Contacts	Authorizing Official	Update		Lukens, Mike CFO 6618696180	Briggs, Sharlet CEO 6618696180	4/5/2017 3:14 PM
Contacts	Authorizing Official	Insert			Lukens, Mike CFO 6618696180	10/27/2016 7:33 PM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	8/16/2016 12:00:00 AM	8/16/2016 1:11 PM
Details	Last Recertification Date	Update		9/9/2014 12:00:00 AM	8/31/2015 12:00:00 AM	8/31/2015 5:57 PM
Contacts	Primary Contact	Insert			Mookie, Mooler Pharmacy Purchaser 6618696280	9/9/2014 11:34 AM
Details	Last Recertification Date	Update			9/9/2014 12:00:00 AM	9/9/2014 11:34 AM
Dates	Participating Approval Date	Update			9/13/2013 12:00:00 AM	9/13/2013 6:18 AM
Details	State	Update		Pending	Active	9/13/2013 6:18 AM
Dates	Start Date	Update			10/1/2013 12:00:00 AM	9/13/2013 6:18 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH050455A	7/19/2013 11:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/15/2013 6:39 PM
Medicaid Billing	Medicaid: Number	Insert			HSC30455F	7/15/2013 6:39 PM
Medicaid Billing	Medicaid: State	Insert			CA	7/15/2013 6:39 PM
Medicaid Billing	NPI: Number	Insert			1538157508	7/15/2013 6:39 PM
Details	Last Recertification Date	Insert				7/15/2013 6:39 PM
Details	Grant Number	Insert				7/15/2013 6:39 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	7/15/2013 6:39 PM
Details	Is Authorizing Official EHB Data	Insert				7/15/2013 6:39 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2013 6:39 PM
Details	Medicare Provider Number	Insert			050455	7/15/2013 6:39 PM
Details	Entity Name	Insert			San Joaquin Community Hospital	7/15/2013 6:39 PM
Details	Program Code	Insert			DSH	7/15/2013 6:39 PM
Details	Entity Subname	Insert			Quest Imaging	7/15/2013 6:39 PM
Dates	Participating Approval Date	Insert				7/15/2013 6:39 PM
Details	State	Insert			Pending	7/15/2013 6:39 PM
Dates	Registration Date	Insert			7/15/2013 12:00:00 AM	7/15/2013 6:39 PM
Dates	Signed By Date	Insert			7/15/2013 12:00:00 AM	7/15/2013 6:39 PM
Dates	Start Date	Insert				7/15/2013 6:39 PM
Terminations	Termination Comments	Insert				7/15/2013 6:39 PM
Terminations	Termination Date	Insert				7/15/2013 6:39 PM
Terminations	Termination Effective Date	Insert				7/15/2013 6:39 PM
Terminations	Termination Reason	Insert				7/15/2013 6:39 PM