Covered Entity Details

DSH050042B ST ELIZABETH COMMUNITY HOSPITAL (Active) - information as of 6/21/2025 12:06:15 AM

Main Details

Name

ST ELIZABETH COMMUNITY HOSPITAL

Subdivision Name

St.Elizabeth Community Hospital Wound Center

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH050042B

Medicare Provider Number

050042

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/17/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/4/2016

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Dignity Health
Rob Lowes, CFO
(530) 225-6390

Primary Contact

St Elizabeth Community Hospital
Alyssa Joann Denham, Pharmacy Manager
(530) 529-8063

Addresses

Street Address

2440 Sister Mary Columba Dr. Suite 300
Red bluff, CA 96080

Billing Address

Dignity Health AP Sac
3400 Data Drive
3rd floor
Rancho Cordova, CA 95670

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		1083732853

Shipping Addresses

Shipping Address 1

St. Elizabeth Community Hospital
Dignity Health
2550 Sister Mary Columba Dr
Red Bluff, CA 96080

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
DSH050042A	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	St Elizabeth Outpatient Surgery Center	2340 Liberty Parkway	Red Bluff	CA	Active
DSH050042B	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	St.Elizabeth Community Hospital Wound Center	2440 Sister Mary Columba Dr. Suite 300	Red bluff	CA	Active
DSH050042C	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	Solano Street Medical Clinic	2126 Solano Street	Corning	CA	Terminated
DSH050042D	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	ST ELIZABETH COMMUNITY HOSPITAL OUT-PATIENT RADIOLOGY - RADIOLOGY	2580 Sister Mary Columba Drive	Red Bluff	CA	Active
DSH050042E	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	Dignity Health Lassen Medical Clinic - Red Bluff - Rural Health Clinic	2450 Sister Mary Columba Drive	Red Bluff	CA	Terminated
DSH050042F	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	Dignity Health Lassen Medical Clinic - Cottonwood - Rural Health Clinic	20833 Long Branch Drive	Cottonwood	CA	Terminated
DSH050042G	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	St Elizabeth Outpatient Infusion Center - Outpatient Infusion	2340 Liberty Parkway	Red Bluff	CA	Active
DSH050042H	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	Women's Health Services - Primary Care	2490 Sister Mary Columba Drive	Red Bluff	CA	Terminated
DSH050042J	Child	DSH	ST ELIZABETH COMMUNITY HOSPITAL	St. Elizabeth Oncology Center - Oncology	2340 Liberty Parkway	Red Bluff	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 4:19:32 PM	8/14/2024 6:06:36 PM	8/14/2024 6:06 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 1:05:51 PM	8/14/2023 4:19:32 PM	8/14/2023 4:19 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 4:23:25 PM	8/26/2022 1:05:51 PM	8/26/2022 1:05 PM
Contacts	Authorizing Official	Update	AO Change Request	D'Angina, Joseph CFO Dignity Health 5302256121	Lowes, Rob CFO Dignity Health 5302256390	12/13/2021 7:57 AM
Details	Last Recertification Date	Update	Recertification	8/20/2020 7:57:02 PM	8/16/2021 4:23:25 PM	8/16/2021 4:23 PM
Addresses	Billing Address	Update	Change Request	St. Elizabeth Community Hospital Dignity Health 2550 Sister Mary Columba Dr Red Bluff, CA 96080	Dignity Health AP Sac 3400 Data Drive 3rd floor Rancho Cordova, CA 95670	11/19/2020 12:46 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/20/2020 7:57 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 2:29:01 PM	8/20/2020 7:57:02 PM	8/20/2020 7:57 PM
Contacts	Authorizing Official	Update	Change Request	Pennebaker, Randy COO St Elizabeth Community Hospital 5305298235	D'Angina, Joseph CFO Dignity Health 5302256121	1/28/2020 8:45 AM
Contacts	Primary Contact	Update	Change Request	Jivan, Jay Kumar Pharmacy Manager St. Elizabeth Community Hospital 5305298063	Denham, Alyssa Joann Pharmacy Manager St Elizabeth Community Hospital 5305298063	10/30/2019 8:24 AM
Contacts	Primary Contact	Update	Change Request	Pennebaker, Randy COO St Elizabeth Community Hospital 5305298235	Jivan, Jay Kumar Pharmacy Manager St. Elizabeth Community Hospital 5305298063	10/17/2019 8:11 AM
Contacts	Authorizing Official	Update	Change Request	Miranda, Kim CFO Dignity Health 9164534459	Pennebaker, Randy COO St Elizabeth Community Hospital 5305298235	10/1/2019 9:08 AM
Contacts	Primary Contact	Update	Profile Change Request	Pennebaker, Randy Chief Operating Officer St Elizabeth Community Hospital 5305298235	Pennebaker, Randy COO St Elizabeth Community Hospital 5305298235	9/30/2019 5:08 PM
Contacts	Primary Contact	Update	Profile Change Request	Pennebaker, Randy Pharmacy Director St Elizabeth Community Hospital 5305298235	Pennebaker, Randy Chief Operating Officer St Elizabeth Community Hospital 5305298235	9/30/2019 5:07 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 5:32:08 PM	8/27/2019 2:29:01 PM	8/27/2019 2:29 PM
Addresses	Main Address	Update	Change Request	2440 Sister Mary Columbia Dr., Suite 300 Red bluff, CA 96080	2440 Sister Mary Columba Dr. Suite 300 Red bluff, CA 96080	6/21/2019 11:48 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 3:26:54 PM	8/21/2018 5:32:08 PM	8/21/2018 5:32 PM
Details	Last Recertification Date	Update	Recertification		11/15/2017 3:26:54 PM	11/15/2017 3:26 PM
Contacts	Primary Contact	Update		Pennebaker, Randy Pharmacy Director 5305298235	Pennebaker, Randy Pharmacy Director St Elizabeth Community Hospital 5305298235	10/18/2017 3:37 PM
Contacts	Authorizing Official	Update		Miranda, Kim CFO 9164534459	Miranda, Kim CFO Dignity Health 9164534459	9/26/2017 6:04 PM
Contacts	Signed By	Update		Miranda, Kim CFO 9164534459	Miranda, Kim CFO Dignity Health 9164534459	9/26/2017 6:04 PM
Contacts	Authorizing Official	Insert			Miranda, Kim CFO 9164534459	7/21/2017 4:52 PM
Contacts	Signed By	Insert			Miranda, Kim CFO 9164534459	7/21/2017 4:52 PM
Addresses	Main Address	Insert			2440 Sister Mary Columbia Dr., Suite 300 Red bluff, CA 96080	3/21/2017 6:23 PM
Addresses	Billing Address	Insert			St. Elizabeth Community Hospital Dignity Health 2550 Sister Mary Columba Dr Red Bluff, CA 96080	3/21/2017 6:23 PM
Addresses	Shipping Address	Insert			St. Elizabeth Community Hospital Dignity Health 2550 Sister Mary Columba Dr Red Bluff, CA 96080	3/21/2017 6:23 PM
Contacts	Primary Contact	Insert			Pennebaker, Randy Pharmacy Director 5305298235	3/21/2017 6:23 PM
Medicaid Billing	NPI: Number	Update		1087373285	1083732853	3/21/2017 6:22 PM
Dates	Participating Approval Date	Update			11/4/2016 12:00:00 AM	11/4/2016 1:03 PM
Details	State	Update		Pending	Active	11/4/2016 1:03 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/4/2016 1:03 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_73467	DSH050042B	11/4/2016 11:16 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_73467	10/17/2016 2:13 PM
Medicaid Billing	NPI: Number	Insert			1087373285	10/17/2016 2:13 PM
Details	Last Recertification Date	Insert				10/17/2016 2:13 PM
Details	Grant Number	Insert				10/17/2016 2:13 PM
Details	340B ID	Insert				10/17/2016 2:13 PM
Details	Is Authorizing Official EHB Data	Insert				10/17/2016 2:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/17/2016 2:13 PM
Details	Medicare Provider Number	Insert			050042	10/17/2016 2:13 PM
Details	Entity Name	Insert			ST ELIZABETH COMMUNITY HOSPITAL	10/17/2016 2:13 PM
Details	Program Code	Insert			DSH	10/17/2016 2:13 PM
Details	Entity Subname	Insert			St.Elizabeth Community Hospital Wound Center	10/17/2016 2:13 PM
Dates	Participating Approval Date	Insert				10/17/2016 2:13 PM
Details	State	Insert			Pending	10/17/2016 2:13 PM
Dates	Registration Date	Insert			10/17/2016 12:00:00 AM	10/17/2016 2:13 PM
Dates	Signed By Date	Insert			10/17/2016 12:00:00 AM	10/17/2016 2:13 PM
Dates	Start Date	Insert				10/17/2016 2:13 PM
Terminations	Termination Comments	Insert				10/17/2016 2:13 PM
Terminations	Termination Date	Insert				10/17/2016 2:13 PM
Terminations	Termination Effective Date	Insert				10/17/2016 2:13 PM
Terminations	Termination Reason	Insert				10/17/2016 2:13 PM