Covered Entity Details

DSH050077BA SCRIPPS MERCY HOSPITAL (Terminated) - information as of 5/6/2025 10:59:21 PM

Main Details

Name

SCRIPPS MERCY HOSPITAL

Subdivision Name

Physical Therapy / PT

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050077BA

Medicare Provider Number

050077

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/8/2014

Participating Start Date

1/1/2015

Participating Approval Date

11/5/2014

Last Recertification Date

8/20/2015

Termination Date
Termination Reason

10/1/2016
Site closure

Contacts

Authorizing Official

Scripps Mercy Hospital
Tom Gammiere, CEO
(619) 260-7101

Primary Contact

Scripps Mercy Hospital
Sherrie Todd, Director of Pharmacy Purchasing and 340B Program
(858) 678-7112

Addresses

Street Address

4094 4th Ave
Suite 300
San Diego, CA 92103

Billing Address

Scripps Mercy Hospital
4077 5th Avenue
San Diego, CA 92103

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
		1659359446

Shipping Addresses

Shipping Address 1

Scripps Mercy Hospital
4077 5th Avenue
San Diego, CA 92103

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
DSH050077A	Child	DSH	SCRIPPS MERCY HOSPITAL - CHULA VISTA		435 H STREET	CHULA VISTA	CA	Terminated
DSH050077AA	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Mercy Infusion Center/Scripps Prebys Cancer Center, Cancer Treatment Room	4044 Fifth Avenue	San Diego	CA	Active
DSH050077AB	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / MRI	435 H. St	Chula Vista	CA	Active
DSH050077AC	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / CT	435 H. St	Chula Vista	CA	Active
DSH050077AD	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Radiology-Diag	435 H. St.	Chula Vista	CA	Active
DSH050077AE	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / L&D	435 H. St.	Chula Vista	CA	Terminated
DSH050077AF	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Pre-Surgical Evaluation	435 H. St	Chula Vista	CA	Terminated
DSH050077AG	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Pre-Op Surgery	435 H. St	Chula Vista	CA	Terminated
DSH050077AH	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Recovery Room	435 H. St	Chula Vista	CA	Active
DSH050077AJ	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Surgery	435 H. St	Chula Vista	CA	Active
DSH050077AK	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health - Mercy Clinic / Internal Medicine Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AL	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health- Mercy Clinic / Trauma-Hospital Follow up Clinc	4020 5th Ave	San Diego	CA	Terminated
DSH050077AM	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health- Mercy Clinic / Pain Management Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AN	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health- Mercy Clinic / Gastroenterology Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AP	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health - Mercy Clinic / Rheumatology Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AQ	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health-Mercy Clinic / Pulmonary Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AR	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health-Mercy Clinic / Orthopedic Trauma Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AS	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health-Mercy Clinic / Neurology Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AT	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health-Mercy Clinic / Renal Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AU	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health-Mercy Clinic / Podiatry Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AV	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health- Mercy Clinic / Endocrine Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AW	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health- Mercy Clinic / CHF Clinic	4020 5th Ave	San diego	CA	Terminated
DSH050077AX	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health- Mercy Clinic / Cardiology Clinic	4020 5th Ave	San Diego	CA	Terminated
DSH050077AY	Child	DSH	SCRIPPS MERCY HOSPITAL	Mercy San Diego Outpatient Rehab / OT	4094 4th Ave., Suite 300	San Diego	CA	Terminated
DSH050077AZ	Child	DSH	SCRIPPS MERCY HOSPITAL	ST / Mercy San Diego ST	4094 4th Ave	San Diego	CA	Terminated
DSH050077B	Child	DSH	SCRIPPS MERCY HOSPITAL	MERCY CLINIC	550 Washington Street	SAN DIEGO	CA	Terminated
DSH050077BA	Child	DSH	SCRIPPS MERCY HOSPITAL	Physical Therapy / PT	4094 4th Ave	San Diego	CA	Terminated
DSH050077BB	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Blood Bank	435 H. St	Chula Vista	CA	Active
DSH050077BC	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista/Procedural Recovery Room	435 H Street	Chula Vista	CA	Active
DSH050077BD	Child	DSH	SCRIPPS MERCY HOSPITAL	Breast Care Center	550 Washington Street	San Diego	CA	Active
DSH050077BE	Child	DSH	SCRIPPS MERCY HOSPITAL	Scripps Health-Mercy Clinic / Antiocoagulation Clinic	4020 5th ave	San Diego	CA	Terminated
DSH050077BF	Child	DSH	SCRIPPS MERCY HOSPITAL	Mercy Clinic - Medication Management Clinic	4077 5th Ave	San Diego	CA	Active
DSH050077C	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / PET Team	435 H St	Chula Vista	CA	Terminated
DSH050077D	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / ER	435 H St	Chula Vista	CA	Active
DSH050077E	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Dialysis	435 H St	Chula Vista	CA	Active
DSH050077F	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Endoscopy	435 H St	Chula Vista	CA	Active
DSH050077G	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / EEG	435 H st	Chula Vista	CA	Active
DSH050077H	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Cardiac Rehab	435 H St	Chula Vista	CA	Terminated
DSH050077J	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / PULMONARY FUNCTION	435 H St	Chula Vista	CA	Terminated
DSH050077K	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Telemetry	435 H. St	Chula Vista	CA	Terminated
DSH050077L	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Echocardiology	435 H. St	Chula Vista	CA	Active
DSH050077M	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / EKG	435 H. St	Chula Vista	CA	Active
DSH050077N	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / OT	450 Fourth Ave	Chula Vista	CA	Terminated
DSH050077P	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / ST	450 Fourth AVe	Chula Vista	CA	Terminated
DSH050077Q	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / PT	450 Fourth Ave	Chula Vista	CA	Terminated
DSH050077R	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Resp Therapy	435 H. St	Chula Vista	CA	Active
DSH050077T	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Pathology	435 H. St	Chula Vista	CA	Active
DSH050077U	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Lab	435 H. St	Chula Vista	CA	Terminated
DSH050077V	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Cardiac Cath	435 H. St	Chula Vista	CA	Active
DSH050077W	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Nuclear Med	435 H. St	Chula Vista	CA	Active
DSH050077X	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Ultrasonography	480 Fourth Ave	Chula Vista	CA	Active
DSH050077Y	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Breast Care Center	480 Fourth Ave	Chula Vista	CA	Active
DSH050077Z	Child	DSH	SCRIPPS MERCY HOSPITAL	Chula Vista / Interventional Radiology	435 H. St	Chula Vista	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Todd, Sherrie Director of Pharmacy 340B Program Scripps Mercy Hospital 6192607308	Todd, Sherrie Director of Pharmacy Purchasing and 340B Program Scripps Mercy Hospital 8586787112	11/21/2023 12:49 PM
Contacts	Authorizing Official	Update		Gammiere, Tom CEO 6192607101	Gammiere, Tom CEO Scripps Mercy Hospital 6192607101	10/9/2017 2:33 PM
Contacts	Signed By	Update		Gammiere, Tom CEO 6192607101	Gammiere, Tom CEO Scripps Mercy Hospital 6192607101	10/9/2017 2:33 PM
Contacts	Primary Contact	Update		Todd, Sherrie Director of Pharmacy 340B Program 6192607308	Todd, Sherrie Director of Pharmacy 340B Program Scripps Mercy Hospital 6192607308	10/4/2017 6:02 PM
Contacts	Authorizing Official	Insert			Gammiere, Tom CEO 6192607101	7/20/2017 12:54 PM
Contacts	Signed By	Insert			Gammiere, Tom CEO 6192607101	7/20/2017 12:54 PM
Contacts	Primary Contact	Insert			Todd, Sherrie Director of Pharmacy 340B Program 6192607308	5/22/2017 12:30 PM
Addresses	Main Address	Insert			4094 4th Ave Suite 300 San Diego, CA 92103	7/28/2016 4:05 PM
Addresses	Billing Address	Insert			Scripps Mercy Hospital 4077 5th Avenue San Diego, CA 92103	7/28/2016 4:05 PM
Addresses	Shipping Address	Insert			Scripps Mercy Hospital 4077 5th Avenue San Diego, CA 92103	7/28/2016 4:05 PM
Dates	Last Date That 340B Drugs Purchased	Update			4/30/2016 12:00:00 AM	7/28/2016 4:05 PM
Details	State	Update		Active	Terminated	7/28/2016 4:05 PM
Terminations	Termination Comments	Update			Service was moved to within the 4 walls of the parent site	7/28/2016 4:05 PM
Terminations	Termination Date	Update			10/1/2016 12:00:00 AM	7/28/2016 4:05 PM
Terminations	Termination Effective Date	Update			4/30/2016 12:00:00 AM	7/28/2016 4:05 PM
Terminations	Termination Reason	Update			Site closure	7/28/2016 4:05 PM
Details	Last Recertification Date	Update			8/20/2015 12:00:00 AM	8/20/2015 2:36 PM
Details	Entity Subname	Update		Physical Therapy	Physical Therapy / PT	11/5/2014 5:39 PM
Dates	Participating Approval Date	Update			11/5/2014 12:00:00 AM	11/5/2014 5:39 PM
Details	State	Update		Pending	Active	11/5/2014 5:39 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	11/5/2014 5:39 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_46726	DSH050077BA	10/10/2014 1:43 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_46726	10/8/2014 12:44 PM
Medicaid Billing	NPI: Number	Insert			1659359446	10/8/2014 12:44 PM
Details	Last Recertification Date	Insert				10/8/2014 12:44 PM
Details	Grant Number	Insert				10/8/2014 12:44 PM
Details	340B ID	Insert				10/8/2014 12:44 PM
Details	Is Authorizing Official EHB Data	Insert				10/8/2014 12:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/8/2014 12:44 PM
Details	Medicare Provider Number	Insert			050077	10/8/2014 12:44 PM
Details	Entity Name	Insert			SCRIPPS MERCY HOSPITAL	10/8/2014 12:44 PM
Details	Program Code	Insert			DSH	10/8/2014 12:44 PM
Details	Entity Subname	Insert			Physical Therapy	10/8/2014 12:44 PM
Dates	Participating Approval Date	Insert				10/8/2014 12:44 PM
Details	State	Insert			Pending	10/8/2014 12:44 PM
Dates	Registration Date	Insert			10/8/2014 12:00:00 AM	10/8/2014 12:44 PM
Dates	Signed By Date	Insert			10/8/2014 12:00:00 AM	10/8/2014 12:44 PM
Dates	Start Date	Insert				10/8/2014 12:44 PM
Terminations	Termination Comments	Insert				10/8/2014 12:44 PM
Terminations	Termination Date	Insert				10/8/2014 12:44 PM
Terminations	Termination Effective Date	Insert				10/8/2014 12:44 PM
Terminations	Termination Reason	Insert				10/8/2014 12:44 PM