Covered Entity Details

DSH050100S SHARP MEMORIAL HOSPITAL (Active) - information as of 5/20/2025 11:45:29 PM

Main Details

Name

SHARP MEMORIAL HOSPITAL

Subdivision Name

Sharp Memorial Outpatient Pavilion - PET Scanner

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050100S

Medicare Provider Number

050100

Outpatient Facility Provider Number

050100

Additional Details

Current Program Status

Active

Registration Date

7/7/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/3/2014

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Sharp HealthCare
Tony Guerra, Chief Financial Officer
(858) 939-4090

Primary Contact

Sharp HealthCare
Zephyr T Skeets, 340B Specialist
(858) 499-2148

Addresses

Street Address

3075 Health Center Dr
San Diego, CA 92123

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	HSC30100F	1407839921

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
DSH050100AA	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Downtown Senior Health Center	956 Tenth Ave	San Diego	CA	Terminated
DSH050100AB	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Home Care Services	8080 Dagget St	San Diego	CA	Terminated
DSH050100AC	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - C/S Surgery	3003 Health Center Dr	San Diego	CA	Active
DSH050100AD	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - C/S Surgery	3075 Health Center Dr	San Diego	CA	Active
DSH050100AE	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - O/P Imaging	3075 Health Center Dr	San Diego	CA	Active
DSH050100AF	Child	DSH	SHARP MEMORIAL HOSPITAL	Outpatient Pavilion / Diabetes Clinic	3075 Health Center Dr	San Diego	CA	Active
DSH050100AG	Child	DSH	SHARP MEMORIAL HOSPITAL	Rehabilitation / Outpatient Clinic	2999 Health Center Dr	San Diego	CA	Active
DSH050100AH	Child	DSH	SHARP MEMORIAL HOSPITAL	Heart Transplant Clinic - Post Heart Transplant-O/P	3075 Health Center Dr.	SAN DIEGO	CA	Active
DSH050100AJ	Child	DSH	SHARP MEMORIAL HOSPITAL	Kidney Transplant Clinic - Post Kidney Transplant-O/P	8010 Frost Street	San Diego	CA	Active
DSH050100AK	Child	DSH	SHARP MEMORIAL HOSPITAL	Pancreas Transplant Clinic - Post Pancreas Transplant-O/P	8010 Frost Street	San Diego	CA	Active
DSH050100AL	Child	DSH	SHARP MEMORIAL HOSPITAL	SHARP MEMORIAL HOSPITAL - Nemeth NICU Follow Up Clinic	8010 Frost Street	San Diego	CA	Active
DSH050100B	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns	3003 Health Center Drive	San Diego	CA	Terminated
DSH050100C	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Women's Surgery	3003 Health Center Dr	San Diego	CA	Active
DSH050100D	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Women's Recovery	3003 Health Center Dr	San Diego	CA	Active
DSH050100E	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Surgical Recovery (PACU)	3003 Health Center Dr	San Diego	CA	Active
DSH050100F	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - O/P Surgery Center	3003 Health Center Dr	San Diego	CA	Active
DSH050100G	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Triage/Urgent Care	3003 Health Center Dr	San Diego	CA	Active
DSH050100H	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Maternal & Fetal	3003 Health Center Dr	San Diego	CA	Active
DSH050100J	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Lactation	3003 Health Center Dr	San Diego	CA	Active
DSH050100K	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Labor & Delivery	3003 Health Center Dr	San Diego	CA	Active
DSH050100L	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Radiology Diagnostic	3003 Health Center Dr	San Diego	CA	Active
DSH050100M	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Respiratory Therapy	3003 Health Center Dr	San Diego	CA	Active
DSH050100N	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Newborn Hearing Screening	3003 Health Center Dr	San Diego	CA	Active
DSH050100P	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - O/P Surgery Center	3075 Health Center Dr	San Diego	CA	Active
DSH050100Q	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Endoscopy	3075 Health Center Dr	San Diego	CA	Active
DSH050100R	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Radiology Diagnostic	3075 Health Center Dr	San Diego	CA	Active
DSH050100S	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - PET Scanner	3075 Health Center Dr	San Diego	CA	Active
DSH050100T	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Radiation Therapy	3075 Health Center Dr	San Diego	CA	Active
DSH050100U	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - CT Scan	3075 Health Center Dr	San Diego	CA	Active
DSH050100V	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Ultrasound	3075 Health Center Dr	San Diego	CA	Active
DSH050100W	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - O/P Infusion Clinic	8010 Frost Street	San Diego	CA	Active
DSH050100X	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Ophthalmology	3075 Health Center Dr	San Diego	CA	Terminated
DSH050100Y	Child	DSH	SHARP MEMORIAL HOSPITAL	Heart Transplant/Mechanical Circulatory Support Clinic	3075 Health Center Dr.	San Diego	CA	Active
DSH050100Z	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp-Clairemont Senior Health Center	4320 Genesee Ave	San Diego	CA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 6:34:39 AM	8/12/2024 11:42:02 AM	8/12/2024 11:42 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 2:17:15 PM	8/29/2023 6:34:39 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 2:18:51 PM	9/7/2022 2:17:15 PM	9/7/2022 2:17 PM
Details	Last Recertification Date	Update	Recertification	8/21/2020 11:45:48 AM	8/25/2021 2:18:51 PM	8/25/2021 2:18 PM
Details	Last Recertification Date	Update	Recertification	9/12/2019 4:27:14 PM	8/21/2020 11:45:48 AM	8/21/2020 11:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/14/2020 12:24 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		HSC30100F	8/14/2020 12:24 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	8/14/2020 12:24 PM
Medicaid Billing	NPI: State	Update	Change Request		CA	8/14/2020 12:24 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 12:24 PM
Details	Last Recertification Date	Update	Recertification	9/6/2018 5:46:45 PM	9/12/2019 4:27:14 PM	9/12/2019 4:27 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 12:25:06 PM	9/6/2018 5:46:45 PM	9/6/2018 5:46 PM
Details	Last Recertification Date	Update	Recertification	9/7/2016 12:00:00 AM	11/15/2017 12:25:06 PM	11/15/2017 12:25 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	Update		3075 Health Center Dr. SAN DIEGO, CA 92123	3075 Health Center Dr San Diego, CA 92123	9/7/2016 7:18 AM
Addresses	Main Address	Insert			3075 Health Center Dr. SAN DIEGO, CA 92123	9/7/2016 7:18 AM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	9/7/2016 12:00:00 AM	9/7/2016 7:18 AM
Details	Last Recertification Date	Update			8/19/2015 12:00:00 AM	8/19/2015 9:19 AM
Details	Entity Subname	Update		Sharp Memorial Outpatient Pavilion - PET Scanner / PET SCANNER	Sharp Memorial Outpatient Pavilion - PET Scanner	12/31/2014 3:51 PM
Details	Entity Subname	Update		Sharp Memorial Outpatient Pavilion - PET Scanner	Sharp Memorial Outpatient Pavilion - PET Scanner / PET SCANNER	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			9/3/2014 12:00:00 AM	9/3/2014 10:00 AM
Details	State	Update		Pending	Active	9/3/2014 10:00 AM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/3/2014 10:00 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_44541	DSH050100S	9/1/2014 6:55 AM
Details	Entity Subname	Update		Sharp Memorial Outpatient Pavilion	Sharp Memorial Outpatient Pavilion - PET Scanner	9/1/2014 6:55 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_44541	7/7/2014 11:23 AM
Medicaid Billing	NPI: Number	Insert			1407839921	7/7/2014 11:23 AM
Details	Last Recertification Date	Insert				7/7/2014 11:23 AM
Details	Grant Number	Insert				7/7/2014 11:23 AM
Details	340B ID	Insert				7/7/2014 11:23 AM
Details	Is Authorizing Official EHB Data	Insert				7/7/2014 11:23 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/7/2014 11:23 AM
Details	Medicare Provider Number	Insert			050100	7/7/2014 11:23 AM
Details	Entity Name	Insert			SHARP MEMORIAL HOSPITAL	7/7/2014 11:23 AM
Details	Program Code	Insert			DSH	7/7/2014 11:23 AM
Details	Entity Subname	Insert			Sharp Memorial Outpatient Pavilion	7/7/2014 11:23 AM
Dates	Participating Approval Date	Insert				7/7/2014 11:23 AM
Details	State	Insert			Pending	7/7/2014 11:23 AM
Dates	Registration Date	Insert			7/7/2014 12:00:00 AM	7/7/2014 11:23 AM
Dates	Signed By Date	Insert			7/7/2014 12:00:00 AM	7/7/2014 11:23 AM
Dates	Start Date	Insert				7/7/2014 11:23 AM
Terminations	Termination Comments	Insert				7/7/2014 11:23 AM
Terminations	Termination Date	Insert				7/7/2014 11:23 AM
Terminations	Termination Effective Date	Insert				7/7/2014 11:23 AM
Terminations	Termination Reason	Insert				7/7/2014 11:23 AM