Covered Entity Details

CAH051335-00 BEAR VALLEY COMMUNITY HOSPITAL (Active) - information as of 6/12/2025 10:57:44 PM

Main Details

Name

BEAR VALLEY COMMUNITY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH051335-00

Medicare Provider Number

051335

Additional Details

Current Program Status

Active

Registration Date

4/1/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/4/2022

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Bear Valley Community Healthcare District
Evan Rayner, CEO
(909) 878-8214

Primary Contact

Bear Valley Community Healthcare District
Colin Campbell, Pharmacist
(909) 878-8209

Addresses

Street Address

41870 GARSTIN DR
BIG BEAR, CA 92315

Billing Address

Bear Valley Community Healthcare District
41870 Garstin Drive
Big Bear Lake, CA 92315

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date 7/1/2015, Termination 10/1/2020, Reinstatement 7/1/2022	04/04/2022
5/19/19 originally approved with 340B ID CAH050618-00, but this was corrected the same day to CAH051335-00	05/19/2015

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	07/25/2016	10/01/2016	10/01/2020	10/01/2020
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/07/2017	07/01/2017	10/01/2020	10/01/2020
Contract Detail	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 09739	42136 BIG BEAR BLVD/PO BOX 6966	BIG BEAR LAKE	CA	92315	04/14/2022	07/01/2022		07/01/2022
Contract Detail	WALGREEN CO	DBA: WALGREENS #10420	42107 BIG BEAR BLVD PO BOX 6995	BIG BEAR LAKE	CA	92315-1518	07/25/2016	10/01/2016	10/01/2020	10/01/2020
Contract Detail	WALGREEN CO	DBA: WALGREENS #10420	42107 BIG BEAR BLVD PO BOX 6995	BIG BEAR LAKE	CA	92315-1518	04/11/2022	07/01/2022		07/01/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/25/2016	10/01/2016	10/01/2020	10/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/25/2016	10/01/2016	10/01/2020	10/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/25/2016	10/01/2016	10/01/2020	10/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/25/2016	10/01/2016	10/01/2020	10/01/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH051335-01	Child	CAH	BEAR VALLEY COMMUNITY HOSPITAL	Family Health Center	41820 Garstin Drive	Big Bear Lake	CA	Active
CAH051335-02	Child	CAH	BEAR VALLEY COMMUNITY HOSPITAL	Rural Health Center	1028 W. Big Bear Blvd.	Big Bear City	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/25/2023 12:01:53 PM	8/16/2024 12:35:01 PM	8/16/2024 12:35 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 12:08:45 PM	8/25/2023 12:01:53 PM	8/25/2023 12:01 PM
Details	Last Recertification Date	Update	Recertification		8/30/2022 12:08:45 PM	8/30/2022 12:08 PM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Addresses	Billing Address	Insert	Reinstatement		Bear Valley Community Healthcare District 41870 Garstin Drive Big Bear Lake, CA 92315	4/4/2022 7:53 AM
Addresses	Main Address	Update	Reinstatement	41870 GARSTIN ROAD BIG BEAR LAKE, CA 92315-1649	41870 GARSTIN DR BIG BEAR, CA 92315	4/4/2022 7:53 AM
Medicaid Billing	Medicaid: Number	Delete	Reinstatement	1073553756 (CA)		4/4/2022 7:53 AM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1073553756 ( )		4/4/2022 7:53 AM
Contacts	Authorizing Official	Update	Reinstatement	Friel, John CEO Bear Valley community Hospital 9098788214	Rayner, Evan CEO Bear Valley Community Healthcare District 9098788214	4/4/2022 7:53 AM
Contacts	Signed By	Update	Reinstatement	Sturgeon, Wade COO/CFO Healthcare District 9098788276	Rayner, Evan CEO Bear Valley Community Healthcare District 9098788214	4/4/2022 7:53 AM
Details	Last Recertification Date	Update	Reinstatement	8/21/2019 7:11:16 AM		4/4/2022 7:53 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	9/30/2020 12:00:00 AM		4/4/2022 7:53 AM
Dates	Participating Approval Date	Update	Reinstatement	5/19/2015 12:00:00 AM	4/4/2022 7:53:36 AM	4/4/2022 7:53 AM
Details	State	Update	Reinstatement	Terminated	Approved	4/4/2022 7:53 AM
Dates	Registration Date	Update	Reinstatement	4/8/2015 12:00:00 AM	4/1/2022 1:24:25 PM	4/4/2022 7:53 AM
Dates	Signed By Date	Update	Reinstatement	4/8/2015 12:00:00 AM	4/1/2022 1:24:29 PM	4/4/2022 7:53 AM
Dates	Start Date	Update	Reinstatement	7/1/2015 12:00:00 AM	7/1/2022 12:00:00 AM	4/4/2022 7:53 AM
Terminations	Termination Date	Update	Reinstatement	10/1/2020 12:00:00 AM		4/4/2022 7:53 AM
Terminations	Termination Effective Date	Update	Reinstatement	9/30/2020 12:00:00 AM		4/4/2022 7:53 AM
Terminations	Termination Reason	Update	Reinstatement	Failure to recertify		4/4/2022 7:53 AM
Details	Comments Public	Insert	Reinstatement		Participating Start Date 7/1/2015, Termination 10/1/2020, Reinstatement 7/1/2022	4/4/2022 7:48 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/30/2020 12:00:00 AM	9/16/2020 8:19 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/16/2020 8:19 AM
Terminations	Termination Date	Update	Recertification		10/1/2020 12:00:00 AM	9/16/2020 8:19 AM
Terminations	Termination Effective Date	Update	Recertification		9/30/2020 12:00:00 AM	9/16/2020 8:19 AM
Terminations	Termination Reason	Update	Recertification		Failure to recertify	9/16/2020 8:19 AM
Details	Last Recertification Date	Update	Recertification	9/10/2018 7:35:41 AM	8/21/2019 7:11:16 AM	8/21/2019 7:11 AM
Contacts	Primary Contact	Update	Recertification	Friel, John CEO Bear Valley community Hospital 9098788214	Campbell, Colin Pharmacist Bear Valley Community Healthcare District 9098788209	9/10/2018 7:35 AM
Details	Last Recertification Date	Update	Recertification	11/16/2017 1:52:47 PM	9/10/2018 7:35:41 AM	9/10/2018 7:35 AM
Contacts	Primary Contact	Update	Recertification	Friel, John CEO 9098788214	Egerer, Shelly Executive Assistant Bear Valley Community Healthcare District 9098788214	11/16/2017 1:52 PM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	11/16/2017 1:52:47 PM	11/16/2017 1:52 PM
Contacts	Authorizing Official	Update		Friel, John CEO 9098788214	Friel, John CEO Bear Valley community Hospital 9098788214	10/31/2017 12:46 PM
Contacts	Primary Contact	Update		Egerer, Shelly Executive Assistant Bear Valley Community Healthcare District 9098788214	Friel, John CEO Bear Valley community Hospital 9098788214	10/31/2017 12:46 PM
Contacts	Authorizing Official	Insert			Friel, John CEO 9098788214	7/7/2017 7:19 PM
Contacts	Primary Contact	Update		Phan, Danggiao Director of Pharmacy 9098788209	Friel, John CEO 9098788214	7/7/2017 7:19 PM
Addresses	Main Address	Insert			41870 GARSTIN ROAD BIG BEAR LAKE, CA 92315-1649	6/20/2017 12:46 PM
Addresses	Billing Address	Insert			Bear Valley Community Hospital PO BOX 1649 Big Bear Lake, CA 92315	6/20/2017 12:46 PM
Contacts	Signed By	Insert			Sturgeon, Wade COO/CFO Healthcare District 9098788276	6/20/2017 12:46 PM
Contacts	Primary Contact	Insert			Phan, Danggiao Director of Pharmacy 9098788209	9/6/2016 3:58 PM
Details	Last Recertification Date	Update		8/11/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 3:58 PM
Details	Last Recertification Date	Update			8/11/2015 12:00:00 AM	8/11/2015 7:30 AM
Details	Comments Public	Insert			5/19/19 originally approved with 340B ID CAH050618-00, but this was corrected the same day to CAH051335-00	5/19/2015 5:23 PM
Details	340B ID	Update		CAH050618-00	CAH051335-00	5/19/2015 5:19 PM
Details	Medicare Provider Number	Update		050618	051335	5/19/2015 4:45 PM
Dates	Participating Approval Date	Update			5/19/2015 12:00:00 AM	5/19/2015 2:30 PM
Details	State	Update		Pending	Active	5/19/2015 2:30 PM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	5/19/2015 2:30 PM
Details	340B ID	Update		DEL_04142015_50879	CAH050618-00	5/5/2015 7:49 AM
Details	Medicare Provider Number	Update		999999	050618	5/5/2015 7:49 AM
Details	State	Update		Rejected	Pending	5/5/2015 7:49 AM
Details	340B ID	Update		ONLINE_REG_50879	DEL_04142015_50879	4/14/2015 12:07 PM
Details	Medicare Provider Number	Update		050618	999999	4/14/2015 12:07 PM
Details	State	Update		Pending	Rejected	4/14/2015 12:07 PM
Details	340B ID	Update			ONLINE_REG_50879	4/8/2015 4:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/8/2015 4:09 PM
Medicaid Billing	Medicaid: Number	Insert			1073553756	4/8/2015 4:09 PM
Medicaid Billing	Medicaid: State	Insert			CA	4/8/2015 4:09 PM
Medicaid Billing	NPI: Number	Insert			1073553756	4/8/2015 4:09 PM
Details	Last Recertification Date	Insert				4/8/2015 4:09 PM
Details	Grant Number	Insert				4/8/2015 4:09 PM
Details	340B ID	Insert				4/8/2015 4:09 PM
Details	Is Authorizing Official EHB Data	Insert				4/8/2015 4:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/8/2015 4:09 PM
Details	Medicare Provider Number	Insert			050618	4/8/2015 4:09 PM
Details	Entity Name	Insert			BEAR VALLEY COMMUNITY HOSPITAL	4/8/2015 4:09 PM
Details	Program Code	Insert			CAH	4/8/2015 4:09 PM
Details	Entity Subname	Insert				4/8/2015 4:09 PM
Dates	Participating Approval Date	Insert				4/8/2015 4:09 PM
Details	State	Insert			Pending	4/8/2015 4:09 PM
Dates	Registration Date	Insert			4/8/2015 12:00:00 AM	4/8/2015 4:09 PM
Dates	Signed By Date	Insert			4/8/2015 12:00:00 AM	4/8/2015 4:09 PM
Dates	Start Date	Insert				4/8/2015 4:09 PM
Terminations	Termination Comments	Insert				4/8/2015 4:09 PM
Terminations	Termination Date	Insert				4/8/2015 4:09 PM
Terminations	Termination Effective Date	Insert				4/8/2015 4:09 PM
Terminations	Termination Reason	Insert				4/8/2015 4:09 PM