Details | Last Recertification Date | Update | Recertification | 8/29/2023 6:34:19 AM | 8/12/2024 11:47:32 AM | 8/12/2024 11:47 AM |
Contacts | Primary Contact | Update | Recertification | Sachs, Susan
System Pharmacy Manager
Sharp HealthCare
8584994220 | Skeets, Zephyr T
340B Specialist
Sharp HealthCare
8584992148 | 8/29/2023 6:34 AM |
Details | Last Recertification Date | Update | Recertification | 9/7/2022 2:37:40 PM | 8/29/2023 6:34:19 AM | 8/29/2023 6:34 AM |
Contacts | Authorizing Official | Update | Change Request | SMITH, TIM
CEO
Sharp Memorial Hospital
8589394082 | Guerra, Tony
Chief Financial Officer
Sharp HealthCare
8589394090 | 2/17/2023 1:34 PM |
Details | Last Recertification Date | Update | Recertification | 8/25/2021 2:12:06 PM | 9/7/2022 2:37:40 PM | 9/7/2022 2:37 PM |
Details | Last Recertification Date | Update | Recertification | 8/21/2020 12:05:10 PM | 8/25/2021 2:12:06 PM | 8/25/2021 2:12 PM |
Details | Last Recertification Date | Update | Recertification | 9/12/2019 4:25:57 PM | 8/21/2020 12:05:10 PM | 8/21/2020 12:05 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 8/14/2020 12:19 PM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | HSC30100F | 8/14/2020 12:19 PM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | CA | 8/14/2020 12:19 PM |
Medicaid Billing | NPI: State | Update | Change Request | | CA | 8/14/2020 12:19 PM |
Contacts | Primary Contact | Update | Change Request | Flores, Besher
340B Program Specialist
Sharp Healthcare
8584994678 | Sachs, Susan
System Pharmacy Manager
Sharp HealthCare
8584994220 | 8/14/2020 12:19 PM |
Details | Last Recertification Date | Update | Recertification | 9/6/2018 5:31:14 PM | 9/12/2019 4:25:57 PM | 9/12/2019 4:25 PM |
Details | Last Recertification Date | Update | Recertification | 11/15/2017 12:30:02 PM | 9/6/2018 5:31:14 PM | 9/6/2018 5:31 PM |
Details | Last Recertification Date | Update | Recertification | 8/30/2016 12:00:00 AM | 11/15/2017 12:30:02 PM | 11/15/2017 12:30 PM |
Contacts | Authorizing Official | Update | | SMITH, TIM
CEO
8589394082 | SMITH, TIM
CEO
Sharp Memorial Hospital
8589394082 | 10/5/2017 11:29 AM |
Contacts | Signed By | Update | | SMITH, TIM
CEO
8589394082 | SMITH, TIM
CEO
Sharp Memorial Hospital
8589394082 | 10/5/2017 11:29 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 | | | SMITH, TIM
CEO
8589394082 | 7/14/2017 11:03 AM |
Contacts | Signed By | Insert | | | SMITH, TIM
CEO
8589394082 | 7/14/2017 11:03 AM |
Contacts | Primary Contact | Insert | | | Flores, Besher
340B Program Specialist
8584994678 | 5/5/2017 11:53 AM |
Addresses | Main Address | Insert | | |
3003 Health Center Dr
San Diego, CA 92123 | 9/6/2016 5:08 PM |
Details | Last Recertification Date | Update | | 8/18/2015 12:00:00 AM | 8/30/2016 12:00:00 AM | 9/6/2016 5:08 PM |
Details | Last Recertification Date | Update | | | 8/18/2015 12:00:00 AM | 8/18/2015 10:53 AM |
Details | Entity Subname | Update | | Sharp Mary Birch Hospital for Women and Newborns - Radiology Diagnostic / Radiology Diagnostic | Sharp Mary Birch Hospital for Women and Newborns - Radiology Diagnostic | 12/31/2014 3:51 PM |
Details | Entity Subname | Update | | Sharp Mary Birch Hospital for Women and Newborns - Radiology Diagnostic | Sharp Mary Birch Hospital for Women and Newborns - Radiology Diagnostic / Radiology Diagnostic | 12/19/2014 2:16 PM |
Dates | Participating Approval Date | Update | | | 9/3/2014 12:00:00 AM | 9/3/2014 9:53 AM |
Details | State | Update | | Pending | Active | 9/3/2014 9:53 AM |
Dates | Start Date | Update | | | 10/1/2014 12:00:00 AM | 9/3/2014 9:53 AM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_44520 | DSH050100L | 9/1/2014 6:58 AM |
Details | Entity Subname | Update | | Sharp Mary Birch Hospital for Women and Newborns | Sharp Mary Birch Hospital for Women and Newborns - Radiology Diagnostic | 9/1/2014 6:58 AM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_44520 | 7/7/2014 10:21 AM |
Medicaid Billing | NPI: Number | Insert | | | 1407839921 | 7/7/2014 10:21 AM |
Details | Last Recertification Date | Insert | | | | 7/7/2014 10:21 AM |
Details | Grant Number | Insert | | | | 7/7/2014 10:21 AM |
Details | 340B ID | Insert | | | | 7/7/2014 10:21 AM |
Details | Is Authorizing Official EHB Data | Insert | | | | 7/7/2014 10:21 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/7/2014 10:21 AM |
Details | Medicare Provider Number | Insert | | | 050100 | 7/7/2014 10:21 AM |
Details | Entity Name | Insert | | | SHARP MEMORIAL HOSPITAL | 7/7/2014 10:21 AM |
Details | Program Code | Insert | | | DSH | 7/7/2014 10:21 AM |
Details | Entity Subname | Insert | | | Sharp Mary Birch Hospital for Women and Newborns | 7/7/2014 10:21 AM |
Dates | Participating Approval Date | Insert | | | | 7/7/2014 10:21 AM |
Details | State | Insert | | | Pending | 7/7/2014 10:21 AM |
Dates | Registration Date | Insert | | | 7/7/2014 12:00:00 AM | 7/7/2014 10:21 AM |
Dates | Signed By Date | Insert | | | 7/7/2014 12:00:00 AM | 7/7/2014 10:21 AM |
Dates | Start Date | Insert | | | | 7/7/2014 10:21 AM |
Terminations | Termination Comments | Insert | | | | 7/7/2014 10:21 AM |
Terminations | Termination Date | Insert | | | | 7/7/2014 10:21 AM |
Terminations | Termination Effective Date | Insert | | | | 7/7/2014 10:21 AM |
Terminations | Termination Reason | Insert | | | | 7/7/2014 10:21 AM |