Covered Entity Details

DSH050026H GROSSMONT HOSPITAL (Active) - information as of 5/1/2025 11:43:54 PM

Main Details

Name

GROSSMONT HOSPITAL

Subdivision Name

Brier Patch Outpatient Rehabilitation Services - Occupational Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050026H

Medicare Provider Number

050026

Outpatient Facility Provider Number

050026

Additional Details

Current Program Status

Active

Registration Date

7/2/2014

Participating Start Date

10/1/2014

Participating Approval Date

8/29/2014

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

9000 Wakarusa Street
Bldg D
La Mesa, CA 91942

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	HSC30026G	1528041811

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 6:22:09 PM	9/3/2024 4:36:44 PM	9/3/2024 4:36 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 4:38:37 PM	9/1/2023 6:22:09 PM	9/1/2023 6:22 PM
Details	Last Recertification Date	Update	Recertification	8/27/2021 12:33:48 PM	9/7/2022 4:38:37 PM	9/7/2022 4:38 PM
Addresses	Main Address	Update	Recertification	9000 Wakarusa Street La Mesa, CA 91942	9000 Wakarusa Street Bldg D La Mesa, CA 91942	8/27/2021 12:33 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 6:31:43 PM	8/27/2021 12:33:48 PM	8/27/2021 12:33 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1528041811	8/19/2020 6:31 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/19/2020 6:31 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1528041811 ( )		8/19/2020 6:31 PM
Details	Last Recertification Date	Update	Recertification	9/12/2019 12:42:44 PM	8/19/2020 6:31:43 PM	8/19/2020 6:31 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 4:20:30 PM	9/12/2019 12:42:44 PM	9/12/2019 12:42 PM
Details	Last Recertification Date	Update	Recertification	11/17/2017 3:18:59 PM	9/6/2018 4:20:30 PM	9/6/2018 4:20 PM
Details	Last Recertification Date	Update	Recertification	9/1/2016 12:00:00 AM	11/17/2017 3:18:59 PM	11/17/2017 3:18 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	Insert			Flores, Besher 340B Program Specialist 8584994678	5/5/2017 11:53 AM
Addresses	Main Address	Insert			9000 Wakarusa Street La Mesa, CA 91942	5/3/2017 11:45 AM
Contacts	Signed By	Insert			CORNICELLI, KARI CFO 6197404465	5/3/2017 11:45 AM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/6/2016 1:09 PM
Details	Last Recertification Date	Update			8/17/2015 12:00:00 AM	8/17/2015 1:17 PM
Details	Entity Subname	Update		Brier Patch Outpatient Rehabilitation Services - Occupational Clinic / Occupational Clinic	Brier Patch Outpatient Rehabilitation Services - Occupational Clinic	12/31/2014 3:51 PM
Details	Entity Subname	Update		Brier Patch Outpatient Rehabilitation Services - Occupational Clinic	Brier Patch Outpatient Rehabilitation Services - Occupational Clinic / Occupational Clinic	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			8/29/2014 12:00:00 AM	8/29/2014 9:59 AM
Details	State	Update		Pending	Active	8/29/2014 9:59 AM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	8/29/2014 9:59 AM
Details	Entity Subname	Update		Brier Patch Outpatient Rehabilitation Services	Brier Patch Outpatient Rehabilitation Services - Occupational Clinic	8/29/2014 9:59 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_44199	DSH050026H	7/25/2014 11:34 AM
Details	Entity Subname	Update		Occupational Clinic	Brier Patch Outpatient Rehabilitation Services	7/25/2014 11:34 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_44199	7/2/2014 1:36 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/2/2014 1:36 PM
Medicaid Billing	Medicaid: Number	Insert			HSC30026G	7/2/2014 1:36 PM
Medicaid Billing	Medicaid: State	Insert			CA	7/2/2014 1:36 PM
Medicaid Billing	NPI: Number	Insert			1528041811	7/2/2014 1:36 PM
Details	Last Recertification Date	Insert				7/2/2014 1:36 PM
Details	Grant Number	Insert				7/2/2014 1:36 PM
Details	340B ID	Insert				7/2/2014 1:36 PM
Details	Is Authorizing Official EHB Data	Insert				7/2/2014 1:36 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/2/2014 1:36 PM
Details	Medicare Provider Number	Insert			050026	7/2/2014 1:36 PM
Details	Entity Name	Insert			GROSSMONT HOSPITAL	7/2/2014 1:36 PM
Details	Program Code	Insert			DSH	7/2/2014 1:36 PM
Details	Entity Subname	Insert			Occupational Clinic	7/2/2014 1:36 PM
Dates	Participating Approval Date	Insert				7/2/2014 1:36 PM
Details	State	Insert			Pending	7/2/2014 1:36 PM
Dates	Registration Date	Insert			7/2/2014 12:00:00 AM	7/2/2014 1:36 PM
Dates	Signed By Date	Insert			7/2/2014 12:00:00 AM	7/2/2014 1:36 PM
Dates	Start Date	Insert				7/2/2014 1:36 PM
Terminations	Termination Comments	Insert				7/2/2014 1:36 PM
Terminations	Termination Date	Insert				7/2/2014 1:36 PM
Terminations	Termination Effective Date	Insert				7/2/2014 1:36 PM
Terminations	Termination Reason	Insert				7/2/2014 1:36 PM