| Contacts | Authorizing Official | Update | Profile Change Request | McCulloch, Greg
CFO
Adventist Health Sonora
2095365019 | McCulloch, Greg
President
Adventist Health Sonora
2095365012 | 8/29/2024 6:49 AM |
| Contacts | Signed By | Update | Profile Change Request | McCulloch, Greg
CFO
Adventist Health Sonora
2095365019 | McCulloch, Greg
President
Adventist Health Sonora
2095365012 | 8/29/2024 6:49 AM |
| Details | State | Update | | To Be Terminated | Terminated | 7/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 7/1/2024 12:00:00 AM | 6/18/2024 7:07 AM |
| Details | State | Update | Termination Request | Approved | To Be Terminated | 6/18/2024 7:07 AM |
| Terminations | Termination Comments | Update | Termination Request | | Our DSH% stayed above the 11.75% threshold for DSH eligibility. We request canceling the reinstatement of SCH so we can stay a DSH facility. | 6/18/2024 7:07 AM |
| Terminations | Termination Date | Update | Termination Request | | 7/1/2024 12:00:00 AM | 6/18/2024 7:07 AM |
| Terminations | Termination Effective Date | Update | Termination Request | | 7/1/2024 12:00:00 AM | 6/18/2024 7:07 AM |
| Terminations | Termination Reason | Update | Termination Request | | Change of covered entity type (non-hospital) | 6/18/2024 7:07 AM |
| Addresses | Billing Address | Insert | Reinstatement | | Sonora Community Hospital DBA Adventist Health Sonora
1000 Greenley Road
Sonora, CA 95370 | 6/3/2024 5:28 PM |
| Addresses | Shipping Address | Update | Reinstatement | SONORA COMMUNITY HOSPITAL DBA SONORA REGIONAL MEDICAL CENTER
1000 GREENLEY ROAD
SONORA, CA 95370 | Sonora Community Hospital DBA Adventist Health Sonora
1000 Greenley Road
Sonora, CA 95370 | 6/3/2024 5:28 PM |
| Medicaid Billing | NPI: Number | Insert | Reinstatement | | 1780673376 | 6/3/2024 5:28 PM |
| Medicaid Billing | NPI: State | Insert | Reinstatement | | CA | 6/3/2024 5:28 PM |
| Medicaid Billing | NPI: Number | Insert | Reinstatement | | 1780673376 | 6/3/2024 5:28 PM |
| Medicaid Billing | NPI: State | Insert | Reinstatement | | AZ | 6/3/2024 5:28 PM |
| Medicaid Billing | NPI: Number | Insert | Reinstatement | | 1780673376 | 6/3/2024 5:28 PM |
| Medicaid Billing | NPI: State | Insert | Reinstatement | | NV | 6/3/2024 5:28 PM |
| Contacts | Authorizing Official | Update | Reinstatement | Jahn, Andrew
PRESIDENT/CEO
Sonora Regional Medical Center
2095365012 | McCulloch, Greg
CFO
Adventist Health Sonora
2095365019 | 6/3/2024 5:28 PM |
| Contacts | Signed By | Update | Reinstatement | Jahn, Andrew
PRESIDENT/CEO
Sonora Regional Medical Center
2095365012 | McCulloch, Greg
CFO
Adventist Health Sonora
2095365019 | 6/3/2024 5:28 PM |
| Contacts | Primary Contact | Update | Reinstatement | Pedroni, Ashley
340B Program Specialist
2095363704 | Pedroni, Ashley
340B Program Compliance Analyst
Adventist Health Sonora
2095363704 | 6/3/2024 5:28 PM |
| Details | Last Recertification Date | Update | Reinstatement | 8/19/2016 12:00:00 AM | | 6/3/2024 5:28 PM |
| Details | Entity Name | Update | Reinstatement | SONORA REGIONAL MEDICAL CENTER | ADVENTIST HEALTH SONORA | 6/3/2024 5:28 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 11/13/2014 12:00:00 AM | 6/3/2024 5:28:39 PM | 6/3/2024 5:28 PM |
| Details | State | Update | Reinstatement | Terminated | Approved | 6/3/2024 5:28 PM |
| Dates | Registration Date | Update | Reinstatement | 10/10/2014 12:00:00 AM | 4/4/2024 2:59:56 PM | 6/3/2024 5:28 PM |
| Dates | Signed By Date | Update | Reinstatement | 10/10/2014 12:00:00 AM | 4/4/2024 4:57:26 PM | 6/3/2024 5:28 PM |
| Dates | Start Date | Update | Reinstatement | 1/1/2015 12:00:00 AM | 7/1/2024 12:00:00 AM | 6/3/2024 5:28 PM |
| Terminations | Termination Comments | Update | Reinstatement | Registration of Parent Entity as a new entity of DSH was approved. | | 6/3/2024 5:28 PM |
| Terminations | Termination Date | Update | Reinstatement | 4/1/2017 12:00:00 AM | | 6/3/2024 5:28 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 4/1/2017 12:00:00 AM | | 6/3/2024 5:28 PM |
| Terminations | Termination Reason | Update | Reinstatement | Change of covered entity type | | 6/3/2024 5:28 PM |
| Details | Comments Public | Insert | Reinstatement | | Participating Start Date 1/1/2015, Termination Date
4/1/2017, Reinstatement 7/1/2024 | 4/9/2024 1:27 PM |
| Contacts | Authorizing Official | Update | | Jahn, Andrew
PRESIDENT/CEO
2095365012 | Jahn, Andrew
PRESIDENT/CEO
Sonora Regional Medical Center
2095365012 | 10/20/2017 1:34 PM |
| Contacts | Signed By | Update | | Jahn, Andrew
PRESIDENT/CEO
2095365012 | Jahn, Andrew
PRESIDENT/CEO
Sonora Regional Medical Center
2095365012 | 10/20/2017 1:34 PM |
| Contacts | Authorizing Official | Insert | | | Jahn, Andrew
PRESIDENT/CEO
2095365012 | 7/31/2017 4:02 PM |
| Contacts | Signed By | Insert | | | Jahn, Andrew
PRESIDENT/CEO
2095365012 | 7/31/2017 4:02 PM |
| Contacts | Primary Contact | Insert | | | Pedroni, Ashley
340B Program Specialist
2095363704 | 7/31/2017 4:02 PM |
| Details | State | Update | | Active | Terminated | 2/21/2017 1:34 PM |
| Terminations | Termination Comments | Update | | | Registration of Parent Entity as a new entity of DSH was approved. | 2/21/2017 1:34 PM |
| Terminations | Termination Date | Update | | | 4/1/2017 12:00:00 AM | 2/21/2017 1:34 PM |
| Terminations | Termination Effective Date | Update | | | 4/1/2017 12:00:00 AM | 2/21/2017 1:34 PM |
| Terminations | Termination Reason | Update | | | Change of covered entity type | 2/21/2017 1:34 PM |
| Details | Last Recertification Date | Update | | 9/3/2015 12:00:00 AM | 8/19/2016 12:00:00 AM | 8/19/2016 2:29 PM |
| Addresses | Main Address | Insert | | |
12791 CABEZUT ROAD
SONORA, CA 95370 | 8/19/2016 2:29 PM |
| Details | Last Recertification Date | Update | | | 9/3/2015 12:00:00 AM | 9/3/2015 12:51 PM |
| Addresses | Billing Address | Insert | | | SONORA COMMUNITY HOSPITAL DBA SONORA REGIONAL MEDICAL CENTER
1000 GREENLEY ROAD
SONORA, CA 95370 | 11/13/2014 6:15 PM |
| Addresses | Shipping Address | Insert | | | SONORA COMMUNITY HOSPITAL DBA SONORA REGIONAL MEDICAL CENTER
1000 GREENLEY ROAD
SONORA, CA 95370 | 11/13/2014 6:15 PM |
| Dates | Participating Approval Date | Update | | | 11/13/2014 12:00:00 AM | 11/13/2014 6:14 PM |
| Details | State | Update | | Pending | Active | 11/13/2014 6:14 PM |
| Dates | Start Date | Update | | | 1/1/2015 12:00:00 AM | 11/13/2014 6:14 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_47004 | SCH050335-28 | 10/29/2014 9:09 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_47004 | 10/10/2014 1:23 PM |
| Details | Last Recertification Date | Insert | | | | 10/10/2014 1:23 PM |
| Details | Grant Number | Insert | | | | 10/10/2014 1:23 PM |
| Details | 340B ID | Insert | | | | 10/10/2014 1:23 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/10/2014 1:23 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/10/2014 1:23 PM |
| Details | Medicare Provider Number | Insert | | | 050335 | 10/10/2014 1:23 PM |
| Details | Entity Name | Insert | | | SONORA REGIONAL MEDICAL CENTER | 10/10/2014 1:23 PM |
| Details | Program Code | Insert | | | SCH | 10/10/2014 1:23 PM |
| Details | Entity Subname | Insert | | | FOOTHILL PEDIATRICS | 10/10/2014 1:23 PM |
| Dates | Participating Approval Date | Insert | | | | 10/10/2014 1:23 PM |
| Details | State | Insert | | | Pending | 10/10/2014 1:23 PM |
| Dates | Registration Date | Insert | | | 10/10/2014 12:00:00 AM | 10/10/2014 1:23 PM |
| Dates | Signed By Date | Insert | | | 10/10/2014 12:00:00 AM | 10/10/2014 1:23 PM |
| Dates | Start Date | Insert | | | | 10/10/2014 1:23 PM |
| Terminations | Termination Comments | Insert | | | | 10/10/2014 1:23 PM |
| Terminations | Termination Date | Insert | | | | 10/10/2014 1:23 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/10/2014 1:23 PM |
| Terminations | Termination Reason | Insert | | | | 10/10/2014 1:23 PM |