Covered Entity Details

DSH050060AB COMMUNITY REGIONAL MEDICAL CENTER (Active) - information as of 5/20/2025 12:49:27 AM

Main Details

Name

COMMUNITY REGIONAL MEDICAL CENTER

Subdivision Name

FH Radiology Diagnostic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050060AB

Medicare Provider Number

050060

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/6/2017

Participating Start Date

7/1/2017

Participating Approval Date

5/8/2017

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Community Medical Center
Tracy Kiritani, VP Hospital Financial Operations
(559) 324-4844

Primary Contact

Community Medical Center
Joel Weber, Director of Finance -Pharmacy and 340B
(559) 231-1504

Addresses

Street Address

15 E. Audubon Drive
Fresno, CA 93720-1542

Billing Address

Community Regional Medical Center
P.O. Box 1232
Fresno, CA 93715-1231

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	HSP40060F	1104906569

Shipping Addresses

Same as Street Address

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
DSH050060AA	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Ultrasound	15 E. Audubon Drive	Fresno	CA	Active
DSH050060AB	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Radiology Diagnostic	15 E. Audubon Drive	Fresno	CA	Active
DSH050060AC	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Anesthesiology	15 E. Audubon Drive	Fresno	CA	Active
DSH050060AD	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH PACU (Recovery)	15 E. Audubon Drive	Fresno	CA	Active
DSH050060AE	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Surgery	15 E. Audubon Drive	Fresno	CA	Active
DSH050060AF	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Short Stay Surgery	15 E. Audubon Drive	Fresno	CA	Active
DSH050060AG	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	COMMUNITY AMBULATORY INFUSION CENTE	729 N MEDICAL CENTER DR W	CLOVIS	CA	Active
DSH050060AH	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Clinic Prompt Care	290 N. Wayte Lane Ste 1800	Fresno	CA	Terminated
DSH050060AJ	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Home Program Dialysis	215 N. Fresno Street, ste. 150	Fresno	CA	Active
DSH050060AK	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Respiratory Services - Respiratory Therapy	15 E. Audubon Drive	Fresno	CA	Active
DSH050060AL	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Community Dialysis Center - Clovis - Dialysis	501 N. Medical Center Drive East	Clovis	CA	Terminated
DSH050060AM	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	SPECIAL SERVICES CLINIC - Ambulatory Care at Specialty Services Clinic	2315 E ILLINOIS AVE	FRESNO	CA	Active
DSH050060C	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	CALIFORNIA CANCER CENTER	7257 NORTH FRESNO STREET	FRESNO	CA	Terminated
DSH050060E	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Children's Clinic	290N. Wayte Lane, Suite 1200	Fresno	CA	Terminated
DSH050060F	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Clinic-Family Practice	290 N. Wayte Lane Suite 2100	Fresno	CA	Terminated
DSH050060G	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Clinic-Specialty Services	290 N. Wayte Lane Suite 2200	Fresno	CA	Terminated
DSH050060H	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Clinic-Surgery	255 N. Herwaldt Drive	Fresno	CA	Terminated
DSH050060J	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Clinic-OB/GYN	290 N. Wayte Lane Suite 1200	Fresno	CA	Terminated
DSH050060K	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Dental Clinic	290 N. Wayte Lane Suite 2500	Fresno	CA	Terminated
DSH050060L	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Clinic-Medicine	290 N. Wayte Lane Suite 2300	Fresno	CA	Terminated
DSH050060M	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Clinic-Eye	290 N. Wayte Lane Suite 1400	Fresno	CA	Terminated
DSH050060N	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Ambulatory Infusion Center	2335 East Kashian Lane	Fresno	CA	Active
DSH050060P	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Community Dialysis Center-Fresno	215 N. Fresno Street, ste. 150	Fresno	CA	Active
DSH050060Q	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Dialysis Center at CMC-Clovis	685 Medical Center Drive, suite 105	Clovis	CA	Terminated
DSH050060R	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Neuroscience Outpatient Therapy	2335 Kashian Lane Suite 301	Fresno	CA	Terminated
DSH050060S	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	DISEASE MANAGEMENT CENTER	2315 E ILLINOIS AVE	FRESNO	CA	Terminated
DSH050060T	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Cath Lab	15 E. Audubon Drive	Fresno	CA	Active
DSH050060U	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Cardiology	15 E. Audubon Drive	Fresno	CA	Active
DSH050060V	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	Community Outpatient Oncology	2335 E. Kashian Ln, Suite 301	Fresno	CA	Terminated
DSH050060W	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Advanced Diag test CTR	205 E. Riverpark Circle, suite 160	Fresno	CA	Terminated
DSH050060X	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Clinic Special Services	15 E. Audubon Drive	Fresno	CA	Active
DSH050060Y	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH CT Scanner	15 E. Audubon Drive	Fresno	CA	Active
DSH050060Z	Child	DSH	COMMUNITY REGIONAL MEDICAL CENTER	FH Nuclear Medicine	15 E. Audubon Drive	Fresno	CA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Kiritani, Tracy CFO Community Medical Center 5593244844	Kiritani, Tracy VP Hospital Financial Operations Community Medical Center 5593244844	2/19/2025 7:25 AM
Contacts	Primary Contact	Update	Profile Change Request	Weber, Joel 340B Program Director Community Medical Center 5592311504	Weber, Joel Director of Finance -Pharmacy and 340B Community Medical Center 5592311504	2/18/2025 6:17 PM
Details	Last Recertification Date	Update	Recertification	8/25/2023 1:15:06 PM	8/15/2024 5:12:35 PM	8/15/2024 5:12 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 1:00:56 PM	8/25/2023 1:15:06 PM	8/25/2023 1:15 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 5:14:07 PM	8/26/2022 1:00:56 PM	8/26/2022 1:00 PM
Details	Last Recertification Date	Update	Recertification	8/21/2020 4:27:52 PM	8/24/2021 5:14:07 PM	8/24/2021 5:14 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1104906569	8/21/2020 4:27 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/21/2020 4:27 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104906569 ( )		8/21/2020 4:27 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 6:09:15 PM	8/21/2020 4:27:52 PM	8/21/2020 4:27 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 2:08:26 PM	8/27/2019 6:09:15 PM	8/27/2019 6:09 PM
Details	Last Recertification Date	Update	Recertification	11/20/2017 12:35:08 PM	8/23/2018 2:08:26 PM	8/23/2018 2:08 PM
Details	Last Recertification Date	Update	Recertification		11/20/2017 12:35:08 PM	11/20/2017 12:35 PM
Contacts	Authorizing Official	Update		Kiritani, Tracy CFO 5593244844	Kiritani, Tracy CFO Community Medical Center 5593244844	9/21/2017 11:28 AM
Contacts	Primary Contact	Update		Weber, Joel 340B Program Director 5592311504	Weber, Joel 340B Program Director Community Medical Center 5592311504	9/18/2017 5:51 PM
Contacts	Signed By	Insert			Neuman, Christopher CFO 5594596437	8/1/2017 9:02 PM
Contacts	Primary Contact	Insert			Weber, Joel 340B Program Director 5592311504	7/12/2017 1:31 PM
Contacts	Authorizing Official	Insert			Kiritani, Tracy CFO 5593244844	7/12/2017 1:31 PM
Addresses	Main Address	Insert			15 E. Audubon Drive Fresno, CA 93720-1542	7/12/2017 1:31 PM
Addresses	Billing Address	Insert			Community Regional Medical Center P.O. Box 1232 Fresno, CA 93715-1231	7/12/2017 1:31 PM
Dates	Participating Approval Date	Update			5/8/2017 12:00:00 AM	5/8/2017 5:07 PM
Details	State	Update		Pending	Active	5/8/2017 5:07 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	5/8/2017 5:07 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76135	DSH050060AB	5/2/2017 2:46 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76135	4/6/2017 1:41 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/6/2017 1:41 PM
Medicaid Billing	Medicaid: Number	Insert			HSP40060F	4/6/2017 1:41 PM
Medicaid Billing	Medicaid: State	Insert			CA	4/6/2017 1:41 PM
Medicaid Billing	NPI: Number	Insert			1104906569	4/6/2017 1:41 PM
Details	Last Recertification Date	Insert				4/6/2017 1:41 PM
Details	Grant Number	Insert				4/6/2017 1:41 PM
Details	340B ID	Insert				4/6/2017 1:41 PM
Details	Is Authorizing Official EHB Data	Insert				4/6/2017 1:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/6/2017 1:41 PM
Details	Medicare Provider Number	Insert			050060	4/6/2017 1:41 PM
Details	Entity Name	Insert			COMMUNITY REGIONAL MEDICAL CENTER	4/6/2017 1:41 PM
Details	Program Code	Insert			DSH	4/6/2017 1:41 PM
Details	Entity Subname	Insert			FH Radiology Diagnostic	4/6/2017 1:41 PM
Dates	Participating Approval Date	Insert				4/6/2017 1:41 PM
Details	State	Insert			Pending	4/6/2017 1:41 PM
Dates	Registration Date	Insert			4/6/2017 12:00:00 AM	4/6/2017 1:41 PM
Dates	Signed By Date	Insert			4/6/2017 12:00:00 AM	4/6/2017 1:41 PM
Dates	Start Date	Insert				4/6/2017 1:41 PM
Terminations	Termination Comments	Insert				4/6/2017 1:41 PM
Terminations	Termination Date	Insert				4/6/2017 1:41 PM
Terminations	Termination Effective Date	Insert				4/6/2017 1:41 PM
Terminations	Termination Reason	Insert				4/6/2017 1:41 PM