| Details | Last Recertification Date | Update | Recertification | 8/30/2023 6:28:42 PM | 8/20/2024 2:26:10 PM | 8/20/2024 2:26 PM |
| Details | Last Recertification Date | Update | Recertification | 9/9/2022 12:37:19 PM | 8/30/2023 6:28:42 PM | 8/30/2023 6:28 PM |
| Details | Last Recertification Date | Update | Recertification | 8/16/2021 12:48:35 PM | 9/9/2022 12:37:19 PM | 9/9/2022 12:37 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Ancheta, Dennis
Interim Director of Pharmacy
San Antonio Regional Hospital
9099204849 | Ancheta, Dennis
Director of Pharmacy
San Antonio Regional Hospital
9099204849-24849 | 10/18/2021 11:59 AM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2020 1:59:12 PM | 8/16/2021 12:48:35 PM | 8/16/2021 12:48 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 9/1/2020 1:59 PM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2019 2:44:56 PM | 9/1/2020 1:59:12 PM | 9/1/2020 1:59 PM |
| Contacts | Primary Contact | Update | Change Request | Torres, Martin J
Director of Pharmacy
San Antonio Regional Hospital
9099204939 | Ancheta, Dennis
Interim Director of Pharmacy
San Antonio Regional Hospital
9099204849 | 6/15/2020 4:41 PM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2018 7:08:36 PM | 8/19/2019 2:44:56 PM | 8/19/2019 2:44 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Aprato, Peter
Senior Vice President Administrative Services and Compliance
San Antonio Regional Hospital
9099204810 | Aprato, Peter
Compliance Officer
San Antonio Regional Hospital
9096941098 | 11/27/2018 3:22 PM |
| Contacts | Signed By | Update | Profile Change Request | Aprato, Peter
Senior Vice President Administrative Services and Compliance
San Antonio Regional Hospital
9099204810 | Aprato, Peter
Compliance Officer
San Antonio Regional Hospital
9096941098 | 11/27/2018 3:22 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/22/2018 7:08:36 PM | 8/22/2018 7:08 PM |
| Terminations | Termination Reason | Update | | Site closure | | 7/21/2018 12:21 PM |
| Contacts | Primary Contact | Update | Change Request | Vo, Jacqueline
Pharmacy Director
San Antonio Regional Hospital
9099204939 | Torres, Martin J
Director of Pharmacy
San Antonio Regional Hospital
9099204939 | 1/30/2018 3:16 PM |
| Addresses | Shipping Address | Insert | Change Request | | San Antonio Regional Hospital
999 San Bernadino Road
Building 5, Room 118
Upland, CA 91786 | 11/28/2017 1:01 PM |
| Details | State | Update | Change Request | Approved | Active | 11/28/2017 1:01 PM |
| Addresses | Shipping Address | Delete | Reinstatement | San Antonio Regional Hospital
999 San Bernadino Road
Upland, CA 91786 | | 10/30/2017 2:39 PM |
| Addresses | Billing Address | Insert | Reinstatement | | San Antonio Regional Hospital
999 San Bernadino Road
Upland, CA 91786 | 10/30/2017 2:39 PM |
| Addresses | Shipping Address | Insert | Reinstatement | | San Antonio Regional Hospital
999 San Bernadino Road
Upland, CA 91786 | 10/30/2017 2:39 PM |
| Contacts | Primary Contact | Update | Reinstatement | Aprato, Peter
Senior Vice President Administrative Services and Compliance
9099204810 | Vo, Jacqueline
Pharmacy Director
San Antonio Regional Hospital
9099204939 | 10/30/2017 2:39 PM |
| Dates | Participating Approval Date | Update | Reinstatement | | 10/30/2017 2:39:17 PM | 10/30/2017 2:39 PM |
| Details | State | Update | Reinstatement | Pending | Approved | 10/30/2017 2:39 PM |
| Dates | Signed By Date | Update | Reinstatement | 10/14/2016 12:00:00 AM | 10/12/2017 5:38:22 PM | 10/30/2017 2:39 PM |
| Dates | Start Date | Update | Reinstatement | | 1/1/2018 12:00:00 AM | 10/30/2017 2:39 PM |
| Terminations | Termination Reason | Update | Reinstatement | | Site closure | 10/30/2017 2:39 PM |
| Details | Comments Public | Insert | Reinstatement | | Participating 1/1/2017 until terminated effective 10/1/2017; reinstated effective 1/1/2018. | 10/19/2017 7:45 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 7/5/2017 12:00:00 AM | | 10/12/2017 5:38 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 10/28/2016 12:00:00 AM | | 10/12/2017 5:38 PM |
| Details | State | Update | Reinstatement | Terminated | Pending | 10/12/2017 5:38 PM |
| Dates | Registration Date | Update | Reinstatement | 10/14/2016 12:00:00 AM | 10/12/2017 5:38:20 PM | 10/12/2017 5:38 PM |
| Dates | Start Date | Update | Reinstatement | 1/1/2017 12:00:00 AM | | 10/12/2017 5:38 PM |
| Terminations | Termination Comments | Update | Reinstatement | The hospital was not able to implement its 340B program in a timely manner and is therefore terminating its registration. At no time were any 340B purchases made by the hospital. | | 10/12/2017 5:38 PM |
| Terminations | Termination Date | Update | Reinstatement | 10/1/2017 12:00:00 AM | | 10/12/2017 5:38 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 7/5/2017 12:00:00 AM | | 10/12/2017 5:38 PM |
| Terminations | Termination Reason | Update | Reinstatement | Site closure | | 10/12/2017 5:38 PM |
| Contacts | Authorizing Official | Update | | Aprato, Peter
Senior Vice President Administrative Services and Compliance
9099204810 | Aprato, Peter
Senior Vice President Administrative Services and Compliance
San Antonio Regional Hospital
9099204810 | 10/12/2017 5:13 PM |
| Contacts | Signed By | Update | | Aprato, Peter
Senior Vice President Administrative Services and Compliance
9099204810 | Aprato, Peter
Senior Vice President Administrative Services and Compliance
San Antonio Regional Hospital
9099204810 | 10/12/2017 5:13 PM |
| Addresses | Main Address | Insert | | |
12442 Limonite Avenue
Suite 102
Eastvale, CA 91752-2467 | 7/7/2017 11:12 AM |
| Contacts | Authorizing Official | Insert | | | Aprato, Peter
Senior Vice President Administrative Services and Compliance
9099204810 | 7/7/2017 11:12 AM |
| Contacts | Primary Contact | Insert | | | Aprato, Peter
Senior Vice President Administrative Services and Compliance
9099204810 | 7/7/2017 11:12 AM |
| Contacts | Signed By | Insert | | | Aprato, Peter
Senior Vice President Administrative Services and Compliance
9099204810 | 7/7/2017 11:12 AM |
| Details | State | Update | | To Be Terminated | Terminated | 7/7/2017 11:12 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | | | 7/5/2017 12:00:00 AM | 7/7/2017 11:11 AM |
| Details | State | Update | | Active | To Be Terminated | 7/7/2017 11:11 AM |
| Terminations | Termination Comments | Update | | | The hospital was not able to implement its 340B program in a timely manner and is therefore terminating its registration. At no time were any 340B purchases made by the hospital. | 7/7/2017 11:11 AM |
| Terminations | Termination Date | Update | | | 10/1/2017 12:00:00 AM | 7/7/2017 11:11 AM |
| Terminations | Termination Effective Date | Update | | | 7/5/2017 12:00:00 AM | 7/7/2017 11:11 AM |
| Terminations | Termination Reason | Update | | | Site closure | 7/7/2017 11:11 AM |
| Dates | Participating Approval Date | Update | | | 10/28/2016 12:00:00 AM | 10/28/2016 6:14 PM |
| Details | State | Update | | Pending | Active | 10/28/2016 6:14 PM |
| Dates | Start Date | Update | | | 1/1/2017 12:00:00 AM | 10/28/2016 6:14 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_73268 | DSH050099C | 10/25/2016 1:41 PM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_73268 | 10/14/2016 1:16 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1780681189 | 10/14/2016 1:16 PM |
| Details | Last Recertification Date | Insert | | | | 10/14/2016 1:16 PM |
| Details | Grant Number | Insert | | | | 10/14/2016 1:16 PM |
| Details | 340B ID | Insert | | | | 10/14/2016 1:16 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 10/14/2016 1:16 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/14/2016 1:16 PM |
| Details | Medicare Provider Number | Insert | | | 050099 | 10/14/2016 1:16 PM |
| Details | Entity Name | Insert | | | SAN ANTONIO REGIONAL HOSPITAL | 10/14/2016 1:16 PM |
| Details | Program Code | Insert | | | DSH | 10/14/2016 1:16 PM |
| Details | Entity Subname | Insert | | | Eastvale / Urgent Care | 10/14/2016 1:16 PM |
| Dates | Participating Approval Date | Insert | | | | 10/14/2016 1:16 PM |
| Details | State | Insert | | | Pending | 10/14/2016 1:16 PM |
| Dates | Registration Date | Insert | | | 10/14/2016 12:00:00 AM | 10/14/2016 1:16 PM |
| Dates | Signed By Date | Insert | | | 10/14/2016 12:00:00 AM | 10/14/2016 1:16 PM |
| Dates | Start Date | Insert | | | | 10/14/2016 1:16 PM |
| Terminations | Termination Comments | Insert | | | | 10/14/2016 1:16 PM |
| Terminations | Termination Date | Insert | | | | 10/14/2016 1:16 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/14/2016 1:16 PM |
| Terminations | Termination Reason | Insert | | | | 10/14/2016 1:16 PM |