Covered Entity Details

DSH050222E SHARP CHULA VISTA MEDICAL CENTER (Terminated) - information as of 6/7/2025 4:44:17 AM

Main Details

Name

SHARP CHULA VISTA MEDICAL CENTER

Subdivision Name

Infusion Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050222E

Medicare Provider Number

050222

Outpatient Facility Provider Number

050222

Additional Details

Current Program Status

Terminated

Registration Date

7/3/2014

Participating Start Date

10/1/2014

Participating Approval Date

8/29/2014

Last Recertification Date

8/19/2015

Termination Date
Termination Reason

10/1/2016
Site closure

Contacts

Authorizing Official

Sharp Chula Vista Medical Center
RICK KING, CFO
(619) 502-3664

Primary Contact

Sharp Healthcare
Besher Flores, 340B Program Specialist
(858) 499-4678

Addresses

Street Address

754 Medical Center Ct.
Chula Vista, CA 91911

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	HSC30222F

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
DSH050222B	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Diabetes Clinic	765 Medical Center Ct.	Chula Vista	CA	Active
DSH050222C	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Physical Therapy Outpatient	752 Medical Center Ct.	Chula Vista	CA	Active
DSH050222D	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Infusion Center	769 Medical Center Ct.	Chula Vista	CA	Active
DSH050222E	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Infusion Center	754 Medical Center Ct.	Chula Vista	CA	Terminated
DSH050222F	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Infusion Center	752 Medical Center Ct.	Chula Vista	CA	Terminated
DSH050222G	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Ambulatory Care Center	754 Medical Center Ct.	Chula Vista	CA	Terminated
DSH050222H	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Outpatient Surgery Center	765 Medical Center Ct.	Chula Vista	CA	Active
DSH050222J	Child	DSH	SHARP CHULA VISTA MEDICAL CENTER	Radiology	769 Medical Center Ct.	Chula Vista	CA	Active

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	KING, RICK CFO 6195023664	KING, RICK CFO Sharp Chula Vista Medical Center 6195023664	10/5/2017 11:26 AM
Contacts	Signed By	Update	KING, RICK CFO 6195023664	KING, RICK CFO Sharp Chula Vista Medical Center 6195023664	10/5/2017 11:26 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		KING, RICK CFO 6195023664	8/9/2017 11:58 AM
Contacts	Signed By	Insert		KING, RICK CFO 6195023664	8/9/2017 11:58 AM
Contacts	Primary Contact	Insert		Flores, Besher 340B Program Specialist 8584994678	5/5/2017 11:53 AM
Addresses	Main Address	Insert		754 Medical Center Ct. Chula Vista, CA 91911	7/13/2016 9:29 AM
Dates	Last Date That 340B Drugs Purchased	Update		7/3/2014 12:00:00 AM	7/13/2016 9:29 AM
Details	State	Update	Active	Terminated	7/13/2016 9:29 AM
Terminations	Termination Comments	Update		Hi- This building was registered in error. The infusion center is only located at 769 Medical Center CT. We would like it removed from the site.	7/13/2016 9:29 AM
Terminations	Termination Date	Update		10/1/2016 12:00:00 AM	7/13/2016 9:29 AM
Terminations	Termination Effective Date	Update		7/3/2014 12:00:00 AM	7/13/2016 9:29 AM
Terminations	Termination Reason	Update		Site closure	7/13/2016 9:29 AM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/19/2015 9:20 AM
Details	Entity Subname	Update	Infusion Center / Infusion Center	Infusion Center	12/31/2014 3:51 PM
Details	Entity Subname	Update	Infusion Center	Infusion Center / Infusion Center	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update		8/29/2014 12:00:00 AM	8/29/2014 10:33 AM
Details	State	Update	Pending	Active	8/29/2014 10:33 AM
Dates	Start Date	Update		10/1/2014 12:00:00 AM	8/29/2014 10:33 AM
Details	340B ID	Update	OUTPATIENT_ONLINE_REG_44282	DSH050222E	8/25/2014 1:31 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_44282	7/3/2014 9:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert		False	7/3/2014 9:01 AM
Medicaid Billing	Medicaid: Number	Insert		HSC30222F	7/3/2014 9:01 AM
Medicaid Billing	Medicaid: State	Insert		CA	7/3/2014 9:01 AM
Details	Last Recertification Date	Insert			7/3/2014 9:01 AM
Details	Grant Number	Insert			7/3/2014 9:01 AM
Details	340B ID	Insert			7/3/2014 9:01 AM
Details	Is Authorizing Official EHB Data	Insert			7/3/2014 9:01 AM
Dates	Last Date That 340B Drugs Purchased	Insert			7/3/2014 9:01 AM
Details	Medicare Provider Number	Insert		050222	7/3/2014 9:01 AM
Details	Entity Name	Insert		SHARP CHULA VISTA MEDICAL CENTER	7/3/2014 9:01 AM
Details	Program Code	Insert		DSH	7/3/2014 9:01 AM
Details	Entity Subname	Insert		Infusion Center	7/3/2014 9:01 AM
Dates	Participating Approval Date	Insert			7/3/2014 9:01 AM
Details	State	Insert		Pending	7/3/2014 9:01 AM
Dates	Registration Date	Insert		7/3/2014 12:00:00 AM	7/3/2014 9:01 AM
Dates	Signed By Date	Insert		7/3/2014 12:00:00 AM	7/3/2014 9:01 AM
Dates	Start Date	Insert			7/3/2014 9:01 AM
Terminations	Termination Comments	Insert			7/3/2014 9:01 AM
Terminations	Termination Date	Insert			7/3/2014 9:01 AM
Terminations	Termination Effective Date	Insert			7/3/2014 9:01 AM
Terminations	Termination Reason	Insert			7/3/2014 9:01 AM