No
| DSH050122A | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Dameron Hospital Occupational Health | 2021 West March Lane | Stockton | CA | Terminated |
| DSH050122B | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Dameron Hospital Association Sweet Success | 530 West Acacia St | Stockton | CA | Terminated |
| DSH050122C | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Dameron Hospital Association Rehab Services | 420 West Acacia St | Stockton | CA | Terminated |
| DSH050122D | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Dameron Hospital Association Core Labratory | 530 West Acacia St | Stockton | CA | Terminated |
| DSH050122E | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Dameron Hospital Association High Risk Infant Clinic | 420 West Acacia St | Stockton | CA | Terminated |
| DSH050122F | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Alex & Faye Spanos Surgical Pavilion | 445 West Acacia St | Stockton | CA | Active |
| DSH050122G | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Occ Health Services Suite #2 | 420 W. Acacia St | Stockton | CA | Terminated |
| DSH050122H | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Employee Medical Clinic Suite #19 | 530 W. Acacia St | Stocton, CA | CA | Terminated |
| DSH050122J | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Ambulatory Care Center | 530 WEST ACACIA STREET | STOCKTON | CA | Terminated |
| DSH050122K | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Pacific Heart & Vascular Medical Group | 1801 E. March Lane Suite D400 | Stockton | CA | Terminated |
| DSH050122L | Child | DSH | DAMERON HOSPITAL ASSOCIATION | Pacific Heart and Vascular Medical Clinic | 845 S. Fairmont Ave | Lodi | CA | Terminated |
| Contacts | Authorizing Official | Update | Profile Change Request | Karagounis, Timothy
Executive Ancillary Services
Dameron Hospital
2094617596-2092007800 | Karagounis, Timothy
Operations Executive
Dameron Hospital
2094617596-2092007800 | 8/30/2021 1:04 PM |
| Contacts | Authorizing Official | Update | Change Request | Hair, Denise
CNO
Dameron Hospital
2094613133 | Karagounis, Timothy
Executive Ancillary Services
Dameron Hospital
2094617596-2092007800 | 5/20/2020 11:21 AM |
| Details | State | Update | | To Be Terminated | Terminated | 10/1/2018 12:05 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 7/2/2018 12:00:00 AM | 9/7/2018 11:24 AM |
| Details | State | Update | Recertification | Active | To Be Terminated | 9/7/2018 11:24 AM |
| Terminations | Termination Date | Update | Recertification | | 10/1/2018 12:00:00 AM | 9/7/2018 11:24 AM |
| Terminations | Termination Effective Date | Update | Recertification | | 7/2/2018 12:00:00 AM | 9/7/2018 11:24 AM |
| Terminations | Termination Reason | Update | Recertification | | Other | 9/7/2018 11:24 AM |
| Contacts | Primary Contact | Update | Recertification | Downs, Gerald
Director of Pharmacy
2094613129 | Trinh, Mai Ngoc
Dameron's Linacia Pharmacy Manager, Pharmacist in Charge
Dameron Hospital
2092427039 | 12/1/2017 4:24 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2016 12:00:00 AM | 12/1/2017 4:24:26 PM | 12/1/2017 4:24 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Glasberg, Michael
COO
2099445550-3135 | Hair, Denise
CNO
Dameron Hospital
2094613133 | 11/21/2017 11:00 AM |
| Addresses | Main Address | Insert | | |
420 W. Acacia St
suite #20
Stockton, CA 95203 | 11/10/2016 12:18 PM |
| Contacts | Primary Contact | Insert | | | Downs, Gerald
Director of Pharmacy
2094613129 | 11/10/2016 12:18 PM |
| Contacts | Signed By | Insert | | | Hawkins, Janine
CNO
2099445550-3133 | 11/10/2016 12:18 PM |
| Contacts | Authorizing Official | Insert | | | Glasberg, Michael
COO
2099445550-3135 | 11/10/2016 12:18 PM |
| Details | Last Recertification Date | Update | | 8/25/2015 12:00:00 AM | 8/26/2016 12:00:00 AM | 8/26/2016 4:24 PM |
| Details | Last Recertification Date | Update | | 9/3/2014 12:00:00 AM | 8/25/2015 12:00:00 AM | 8/25/2015 11:42 AM |
| Details | Last Recertification Date | Update | | | 9/3/2014 12:00:00 AM | 9/3/2014 12:27 PM |
| Dates | Participating Approval Date | Update | | | 6/11/2014 12:00:00 AM | 6/11/2014 5:28 PM |
| Details | State | Update | | Pending | Active | 6/11/2014 5:28 PM |
| Dates | Start Date | Update | | | 7/1/2014 12:00:00 AM | 6/11/2014 5:28 PM |
| Details | 340B ID | Update | | DeleteAPDSH050122G | DSH050122G | 4/23/2014 7:48 AM |
| Details | State | Update | | Rejected | Pending | 4/23/2014 7:48 AM |
| Details | 340B ID | Update | | DSH050122G | DeleteAPDSH050122G | 4/23/2014 7:46 AM |
| Details | State | Update | | Pending | Rejected | 4/23/2014 7:46 AM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | DSH050122G | 4/23/2014 7:26 AM |
| Details | Last Recertification Date | Insert | | | | 4/11/2014 3:25 PM |
| Details | Grant Number | Insert | | | | 4/11/2014 3:25 PM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 4/11/2014 3:25 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/11/2014 3:25 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/11/2014 3:25 PM |
| Details | Medicare Provider Number | Insert | | | 050122 | 4/11/2014 3:25 PM |
| Details | Entity Name | Insert | | | DAMERON HOSPITAL ASSOCIATION | 4/11/2014 3:25 PM |
| Details | Program Code | Insert | | | DSH | 4/11/2014 3:25 PM |
| Details | Entity Subname | Insert | | | Occ Health Services Suite #2 | 4/11/2014 3:25 PM |
| Dates | Participating Approval Date | Insert | | | | 4/11/2014 3:25 PM |
| Details | State | Insert | | | Pending | 4/11/2014 3:25 PM |
| Dates | Registration Date | Insert | | | 4/11/2014 12:00:00 AM | 4/11/2014 3:25 PM |
| Dates | Signed By Date | Insert | | | 4/11/2014 12:00:00 AM | 4/11/2014 3:25 PM |
| Dates | Start Date | Insert | | | | 4/11/2014 3:25 PM |
| Terminations | Termination Comments | Insert | | | | 4/11/2014 3:25 PM |
| Terminations | Termination Date | Insert | | | | 4/11/2014 3:25 PM |
| Terminations | Termination Effective Date | Insert | | | | 4/11/2014 3:25 PM |
| Terminations | Termination Reason | Insert | | | | 4/11/2014 3:25 PM |