Covered Entity Details

DSH050192AD Reedley Community Hospital dba Adventist Health Reedley (Active) - information as of 5/13/2025 1:46:20 AM

Main Details

Name

Reedley Community Hospital dba Adventist Health Reedley

Subdivision Name

Adventist Health/Community Care Kerman

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH050192AD

Medicare Provider Number

050192

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2015

Participating Start Date

1/1/2016

Participating Approval Date

10/30/2015

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Adventist Health
Timothy Michael Haydock, CFO
(559) 537-0050

Primary Contact

Adventist Health
Ahmed Abukhazneh, Pharmacist, Charge
(559) 537-2190

Addresses

Street Address

1000 S. Madera Avenue
Kerman, CA 93630

Billing Address

Adventist Medical Center Reedley
372 W Cypress Ave
Reedley, CA 93654

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		1902823461,1336167550

Shipping Addresses

Shipping Address 1

Adventist Medical Center Reedley
372 W Cypress Ave
Reedley, CA 93654

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
DSH050192A	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Parlier	155 S. Newmark Ave.	Parlier	CA	Active
DSH050192AA	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Avenal	216 E. Fresno Street	Avenal	CA	Active
DSH050192AB	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Home Garden	11899 Shaw Place	Hanford	CA	Active
DSH050192AC	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Selma Central	2141 High Street	Selma	CA	Active
DSH050192AD	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Kerman	1000 S. Madera Avenue	Kerman	CA	Active
DSH050192AE	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Fowler	300 S. Leon S. Peters Blvd	Fowler	CA	Active
DSH050192AF	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Caruthers	2440 W. Tahoe Ave	Caruthers	CA	Active
DSH050192AG	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Selma	1041 Rose Avenue	Selma	CA	Active
DSH050192AH	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Coalinga	155 S. Fifth Street	Coalinga	CA	Active
DSH050192AJ	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Corcoran	1310 Hanna Ave.	Corcoran	CA	Active
DSH050192AK	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	AHCC Healthy Beginings	1122 N Harris Street	Hanford	CA	Active
DSH050192AL	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	AHCC Specialty Clinic	1025 N. Douty street	Hanford	CA	Active
DSH050192AM	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Dental	1025 N Douty Street Hagen Building	Hanford	CA	Active
DSH050192AN	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Hanford	1025 N. Douty Street	Hanford	CA	Active
DSH050192AP	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Dinuba	1451 E. El Monte Way	Dinuba	CA	Active
DSH050192AQ	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health Community Center/Huron	16916 Fifth Street	Huron	CA	Active
DSH050192AR	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Community Care Reedley Women's Health	550 W Cypress Ave	Reedley	CA	Active
DSH050192AS	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Community Care Oakhurst	48677 Victoria Lane	Oakhurst	CA	Active
DSH050192AT	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Oakhurst East	49063 Rd 426 suite C & D	Oakhurst	CA	Terminated
DSH050192AU	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Madera Ranchos	11976 Rd 37	Madera	CA	Active
DSH050192AV	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Shafter	406 James St	Shafter	CA	Active
DSH050192AW	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Wasco	1040 7th St,	Wasco	CA	Active
DSH050192B	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Children's	1433 N. Acacia Ave	Reedley	CA	Active
DSH050192C	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Cypress	372 W. Cypress Ave	Reedley	CA	Active
DSH050192D	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Dinuba West	250 W. El Monte Way	Dinuba	CA	Active
DSH050192E	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Orange Cove	1455 Park Blvd.	Orange Cove	CA	Active
DSH050192F	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Jefferson	1150 E. Washington Avenue	Reedley	CA	Active
DSH050192G	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Avenal West	337 E Kings Street	Avenal	CA	Active
DSH050192H	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Caruthers East	2357 W. Tahoe	Caruthers	CA	Active
DSH050192J	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Corcoran	1310 Hanna Ave Suite 3	Corcoran	CA	Terminated
DSH050192K	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Kerman	275 S. Madera Avenue	Kerman	CA	Terminated
DSH050192L	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Riverdale	3567 W Mt. Whitney Avenue	Riverdale	CA	Active
DSH050192M	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Orosi	41696 Road 128	Orosi	CA	Active
DSH050192P	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care - Dinuba Plaza	444 W. El Monte Way	Dinuba	CA	Active
DSH050192Q	Child	DSH	Adventist Medical Center - Reedley	Outpatient Obstetrics	372 W Cypress ave.	Reedley	CA	Terminated
DSH050192R	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Outpatient Mammography	372 W Cypress Ave	Reedley	CA	Terminated
DSH050192S	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Outpatient MRI	372 W Cypress Ave	Reedley	CA	Terminated
DSH050192T	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Outpatient C T Scanner	372 W Cypress Ave	Reedley	CA	Terminated
DSH050192U	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	AHCC Family Practice Residency Clinic	1025 N. Douty Street	Hanford	CA	Active
DSH050192V	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Lemoore	810 E. "D" Street	Lemoore	CA	Active
DSH050192W	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Taft	501 6th Street	Taft	CA	Active
DSH050192X	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Kingsburg	1251 Draper Street	Kingsburg	CA	Active
DSH050192Y	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Sanger	1939 Academy Ave	Sanger	CA	Active
DSH050192Z	Child	DSH	Reedley Community Hospital dba Adventist Health Reedley	Adventist Health/Community Care Reedley	811 E 11th Street	Reedley	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 12:59:34 PM	9/3/2024 12:15:28 PM	9/3/2024 12:15 PM
Details	Last Recertification Date	Update	Recertification	9/19/2022 12:08:43 PM	9/6/2023 12:59:34 PM	9/6/2023 12:59 PM
Details	Last Recertification Date	Update	Recertification	9/1/2021 2:27:56 PM	9/19/2022 12:08:43 PM	9/19/2022 12:08 PM
Details	Last Recertification Date	Update	Recertification	8/24/2020 7:07:07 PM	9/1/2021 2:27:56 PM	9/1/2021 2:27 PM
Details	Entity Name	Update	Change Request	Adventist Medical Center - Reedley	Reedley Community Hospital dba Adventist Health Reedley	11/16/2020 7:01 AM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/24/2020 7:07 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/24/2020 7:07 PM
Details	Last Recertification Date	Update	Recertification	9/12/2019 12:32:10 AM	8/24/2020 7:07:07 PM	8/24/2020 7:07 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336167550	12/2/2019 3:33 PM
Details	Last Recertification Date	Update	Recertification	8/16/2018 2:58:58 PM	9/12/2019 12:32:10 AM	9/12/2019 12:32 AM
Contacts	Primary Contact	Update	Change Request	Choi, John Director of Pharmacy Adventist Medical Center Hanford 5595372204	Abukhazneh, Ahmed Pharmacist, Charge Adventist Health 5595372190	7/9/2019 7:41 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 8:41:04 PM	8/16/2018 2:58:58 PM	8/16/2018 2:58 PM
Contacts	Authorizing Official	Update	Change Request	Larsen, David L. SR VP CFO ADVENTIST MEDICAL CENTER REEDLEY 5595370050	Haydock, Timothy Michael CFO Adventist Health 5595370050	4/2/2018 1:50 PM
Details	Entity Name	Update	Change Request	ADVENTIST MEDICAL CENTER REEDLEY	Adventist Medical Center - Reedley	4/2/2018 1:50 PM
Details	Last Recertification Date	Update	Recertification	8/16/2016 12:00:00 AM	11/29/2017 8:41:04 PM	11/29/2017 8:41 PM
Contacts	Authorizing Official	Update		Larsen, David L. SR VP CFO 5595370050	Larsen, David L. SR VP CFO ADVENTIST MEDICAL CENTER REEDLEY 5595370050	11/29/2017 8:24 PM
Contacts	Signed By	Update		Larsen, David L. SR VP CFO 5595370050	Larsen, David L. SR VP CFO ADVENTIST MEDICAL CENTER REEDLEY 5595370050	11/29/2017 8:24 PM
Contacts	Primary Contact	Update		Choi, John Director of Pharmacy 5595372204	Choi, John Director of Pharmacy Adventist Medical Center Hanford 5595372204	10/27/2017 2:17 PM
Contacts	Primary Contact	Insert			Choi, John Director of Pharmacy 5595372204	7/26/2017 2:10 PM
Contacts	Authorizing Official	Insert			Larsen, David L. SR VP CFO 5595370050	7/26/2017 2:10 PM
Contacts	Signed By	Insert			Larsen, David L. SR VP CFO 5595370050	7/26/2017 2:10 PM
Addresses	Main Address	Insert			1000 S. Madera Avenue Kerman, CA 93630	7/26/2017 2:09 PM
Addresses	Billing Address	Insert			Adventist Medical Center Reedley 372 W Cypress Ave Reedley, CA 93654	7/26/2017 2:09 PM
Addresses	Shipping Address	Insert			Adventist Medical Center Reedley 372 W Cypress Ave Reedley, CA 93654	7/26/2017 2:09 PM
Details	Last Recertification Date	Update			8/16/2016 12:00:00 AM	8/16/2016 5:17 PM
Dates	Participating Approval Date	Update			10/30/2015 12:00:00 AM	10/30/2015 10:26 AM
Details	State	Update		Pending	Active	10/30/2015 10:26 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	10/30/2015 10:26 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_55918	DSH050192AD	10/28/2015 9:55 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_55918	10/15/2015 11:58 AM
Medicaid Billing	NPI: Number	Insert			1902823461	10/15/2015 11:58 AM
Details	Last Recertification Date	Insert				10/15/2015 11:58 AM
Details	Grant Number	Insert				10/15/2015 11:58 AM
Details	340B ID	Insert				10/15/2015 11:58 AM
Details	Is Authorizing Official EHB Data	Insert				10/15/2015 11:58 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2015 11:58 AM
Details	Medicare Provider Number	Insert			050192	10/15/2015 11:58 AM
Details	Entity Name	Insert			ADVENTIST MEDICAL CENTER REEDLEY	10/15/2015 11:58 AM
Details	Program Code	Insert			DSH	10/15/2015 11:58 AM
Details	Entity Subname	Insert			Adventist Health/Community Care Kerman	10/15/2015 11:58 AM
Dates	Participating Approval Date	Insert				10/15/2015 11:58 AM
Details	State	Insert			Pending	10/15/2015 11:58 AM
Dates	Registration Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 11:58 AM
Dates	Signed By Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 11:58 AM
Dates	Start Date	Insert				10/15/2015 11:58 AM
Terminations	Termination Comments	Insert				10/15/2015 11:58 AM
Terminations	Termination Date	Insert				10/15/2015 11:58 AM
Terminations	Termination Effective Date	Insert				10/15/2015 11:58 AM
Terminations	Termination Reason	Insert				10/15/2015 11:58 AM