Covered Entity Details

DSH050057AC Kaweah Delta Health Care District DBA Kaweah Health (Active) - information as of 4/28/2025 1:50:27 AM

Main Details

Name

Kaweah Delta Health Care District DBA Kaweah Health

Subdivision Name

Kaweah Health Specialty Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050057AC

Medicare Provider Number

050057

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/10/2017

Participating Start Date

1/1/2018

Participating Approval Date

10/18/2017

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Kaweah Delta Health Care District DBA Kaweah Health
Gary K Herbst, Chief Executive Officer
(559) 624-2330

Primary Contact

Kaweah Delta Health Care District DBA Kaweah Health
Allison E Gonzalez, Pharmacy Business Manager
(559) 624-5328

Addresses

Street Address

325 South Willis Street
Visalia, CA 93291

Billing Address

Kaweah Delta Health Care District DBA Kaweah Health
400 West Mineral King Avenue
Visalia, CA 93291

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	ZZT40057F	1538545520,1659735132,1376566133,1588663769
AZ	024688	1588663769

Shipping Addresses

Shipping Address 1

Kaweah Delta Health Care District DBA Kaweah Health
400 West Mineral King Avenue
Visalia, CA 93291

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
DSH050057A	Child	DSH	KAWEAH DELTA HEALTH CARE DISTRICT	KAWEAH DELTA SKILLED NURSING CENTER	1633 S COURT	VISALIA	CA	Terminated
DSH050057AA	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Dinuba Clinic	355 Monte Vista Drive	Dinuba	CA	Active
DSH050057AB	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Medical Clinic - Willow	202 W. Willow Ave	Visalia	CA	Active
DSH050057AC	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Specialty Clinic	325 South Willis Street	Visalia	CA	Active
DSH050057AD	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Neurosciences Center	325 South Willis	Visalia	CA	Active
DSH050057AE	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Urgent Care (Demaree)	3600 West Flagstaff Avenue	Visalia	CA	Active
DSH050057AF	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Cardiology Center	820 South Akers Street	Visalia	CA	Active
DSH050057AG	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Tulare Clinic - Multi-Specialty	1000 North Mooney Boulevard	Tulare	CA	Active
DSH050057AH	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Diagnostics Center - Nuclear Medicine - Diagnostics Center - Nuclear Medicine	820 South Akers Street	Visalia	CA	Active
DSH050057AJ	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Dialysis Center - CAPD/CCPD Training Services - Dialysis Center - CAPD/CCPD Training Services	5040 West Tulare Avenue	Visalia	CA	Active
DSH050057AK	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Diagnostics Center - PET CT - Diagnostics Center - PET CT	820 South Akers Street	Visalia	CA	Active
DSH050057AL	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Dialysis Center - CAPD/CCPD Clinic - Dialysis Center - CAPD/CCPD Clinic	5040 West Tulare Avenue	Visalia	CA	Active
DSH050057AM	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Diagnostics Center - Non Invasive Cardiology - Diagnostics Center - Non Invasive Cardiology	820 South Akers Street	Visalia	CA	Active
DSH050057AN	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Urology - Urology	325 South Willis Street	Visalia	CA	Active
DSH050057AP	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	KAWEAH HEALTH MEDICAL CENTER - Sequoia Regional Cancer Center–Medical Oncology	4945 W. Cypress	VISALIA	CA	Active
DSH050057AQ	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	KAWEAH DELTA HEALTH CARE DISTRICT - Kaweah Health Cardiology Center - Tulare	938 N CHERRY ST	TULARE	CA	Terminated
DSH050057AR	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	KAWEAH DELTA HEALTH CARE DISTRICT - Kaweah Health Medical Clinic - Plaza	1329 N PLAZA DR	VISALIA	CA	Terminated
DSH050057AS	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	KAWEAH DELTA HEALTH CARE DISTRICT - Kaweah Health Medical Clinic - Ben Maddox	1110 S BEN MADDOX WAY	VISALIA	CA	Terminated
DSH050057AT	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Center for Mental Wellness - Psychotherapy Clinic	301 W Noble Ave	VISALIA	CA	Terminated
DSH050057B	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Imaging & Breast Center	4949 West Cypress Avenue	Visalia	CA	Active
DSH050057C	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Dialysis Center - Hemodialysis	5040 West Tulare Avenue	Visalia	CA	Active
DSH050057D	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Exeter Clinic	1014 San Juan Avenue	Exeter	CA	Active
DSH050057E	Child	DSH	KAWEAH DELTA HEALTH CARE DISTRICT	KAWEAH DELTA PORTERVILLE DIALYSIS	385 N PEARSON	PORTERVILLE	CA	Terminated
DSH050057F	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	KAWEAH DELTA HOME HEALTH AGENCY	403 West Main Street	VISALIA	CA	Terminated
DSH050057G	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Hospice	402 W Acequia Ave	Visalia	CA	Active
DSH050057I	Child	DSH	KAWEAH DELTA HEALTH CARE DISTRICT	KAWEAH DELTA REHABILITATION HOSPITAL	840 S AKERS	VISALIA	CA	Terminated
DSH050057J	Child	DSH	KAWEAH DELTA HEALTH CARE DISTRICT	KAWEAH DELTA MENTAL HEALTH HOSPITAL	1100 S AKERS	VISALIA	CA	Terminated
DSH050057K	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Lindsay Clinic	839 North Sequoia Avenue	Lindsay	CA	Active
DSH050057L	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	THERAPY SPECIALISTS-ORTHOPEDICS AND SPORTS MEDICINE	1337 SOUTH LOVERS LANE	VISALIA	CA	Terminated
DSH050057M	Child	DSH	KAWEAH DELTA HEALTH CARE DISTRICT	THERAPY SPECIALISTS-ORTHOPEDICS AND SPORTS MEDICINE	3362 South Fairway	Visalia	CA	Terminated
DSH050057N	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	EXETER THERAPY SPECIALISTS	1131 Visalia Road	EXETER	CA	Terminated
DSH050057P	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	THERAPY SPECIALISTS	820 S Akers St, Suite 200	VISALIA	CA	Terminated
DSH050057Q	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	SEQUOIA REGIONAL CANCER CENTER (RADIATION ONCOLOGY)	4945 W. CYPRESS AVE., SUITE A	VISALIA	CA	Active
DSH050057R	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	SEQUOIA REGIONAL CANCER CENTER (RADIATION ONCOLOGY HANFORD)	1443 WEST 7TH ST	HANFORD	CA	Terminated
DSH050057S	Child	DSH	KAWEAH DELTA HEALTH CARE DISTRICT	KAWEAH DELTA SLEEP DISORDERS CENTER	126 S. FLORAL ST	VISALIA	CA	Terminated
DSH050057T	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Woodlake Clinic	180 East Antelope Avenue	Woodlake	CA	Active
DSH050057U	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Infusion Center	325 South Willis Street	Visalia	CA	Active
DSH050057V	Child	DSH	KAWEAH DELTA MEDICAL CENTER	KAWEAH DELTA SPECIALTY CLINICS	403 W MAIN ST	VISALIA	CA	Terminated
DSH050057W	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Outpatient Diabetes Center	325 South Willis Street	Visalia	CA	Active
DSH050057X	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Wound Center	840 South Akers Street	Visalia	CA	Terminated
DSH050057Y	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Urgent Care (Court Street)	1633 South Court Street	Visalia	CA	Active
DSH050057Z	Child	DSH	Kaweah Delta Health Care District DBA Kaweah Health	Kaweah Health Imaging & Breast Center (Breast)	4949 West Cypress Avenue	Visalia	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Group Change Request		1588663769	10/14/2024 10:43 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		AZ	10/14/2024 10:43 AM
Details	Last Recertification Date	Update	Recertification	9/1/2023 4:53:30 PM	8/22/2024 10:48:13 AM	8/22/2024 10:48 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1376566133	9/1/2023 4:53 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2023 4:53 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1588663769	9/1/2023 4:53 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2023 4:53 PM
Details	Last Recertification Date	Update	Recertification	9/9/2022 6:37:57 PM	9/1/2023 4:53:30 PM	9/1/2023 4:53 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1659735132	7/18/2023 1:38 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		CA	7/18/2023 1:38 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1588663769 (CA)		9/9/2022 6:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1588663769 (AZ)		9/9/2022 6:37 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1538545520	9/9/2022 6:37 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/9/2022 6:37 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 11:57:43 AM	9/9/2022 6:37:57 PM	9/9/2022 6:37 PM
Contacts	Authorizing Official	Update	AO Change Request	Noeske, Keri Lynn CNO Acting CEO Kaweah Health Medical Center 5596245916	Herbst, Gary K Chief Executive Officer Kaweah Delta Health Care District DBA Kaweah Health 5596242330	9/2/2022 6:54 AM
Contacts	Primary Contact	Update	Group Change Request	Anderson, Jill C Pharmacy Business Manager Kaweah Delta Health Care District DBA Kaweah Health 5596245091	Gonzalez, Allison E Pharmacy Business Manager Kaweah Delta Health Care District DBA Kaweah Health 5596245328	7/29/2022 12:44 PM
Contacts	Authorizing Official	Update	AO Change Request	Herbst, Gary K Chief Executive Officer Kaweah Delta Health Care District DBA Kaweah Health 5596242330	Noeske, Keri Lynn CNO Acting CEO Kaweah Health Medical Center 5596245916	7/15/2022 10:01 AM
Details	Last Recertification Date	Update	Recertification	9/14/2020 12:23:03 PM	8/18/2021 11:57:43 AM	8/18/2021 11:57 AM
Addresses	Shipping Address	Delete	Change Request	Kaweah Delta Health Care District 400 W. Mineral King Ave Visalia, CA 93291		6/30/2021 6:57 AM
Addresses	Main Address	Update	Change Request	325 S. WILLIS STREET VISALIA, CA 93291-6105	325 South Willis Street Visalia, CA 93291	6/30/2021 6:57 AM
Addresses	Billing Address	Update	Change Request	Kaweah Delta Health Care District 400 W Mineral King Ave Visalia, CA 93291	Kaweah Delta Health Care District DBA Kaweah Health 400 West Mineral King Avenue Visalia, CA 93291	6/30/2021 6:57 AM
Addresses	Shipping Address	Insert	Change Request		Kaweah Delta Health Care District DBA Kaweah Health 400 West Mineral King Avenue Visalia, CA 93291	6/30/2021 6:57 AM
Details	Entity Subname	Update	Change Request	KAWEAH DELTA CHRNC DIS MGMT - Chronic Disease Management Clinc	Kaweah Health Specialty Clinic	6/30/2021 6:57 AM
Contacts	Primary Contact	Update	Change Request	Abercrombie, Catherine Pharmacy Business Coordinator Kaweah Delta Health Care District 5596244529	Anderson, Jill C Pharmacy Business Manager Kaweah Delta Health Care District DBA Kaweah Health 5596245091	6/17/2021 4:26 PM
Contacts	Authorizing Official	Update	Change Request	HERBST, GARY K. Chief Executive Officer Kaweah Delta Health Care District 5596242330	Herbst, Gary K Chief Executive Officer Kaweah Delta Health Care District DBA Kaweah Health 5596242330	6/1/2021 3:01 PM
Details	Entity Name	Update	Change Request	KAWEAH DELTA HEALTH CARE DISTRICT	Kaweah Delta Health Care District DBA Kaweah Health	6/1/2021 3:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 12:23 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		ZZT40057F	9/14/2020 12:23 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	9/14/2020 12:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/14/2020 12:23 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		024688	9/14/2020 12:23 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/14/2020 12:23 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1588663769 (CA)		9/14/2020 12:23 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1588663769	9/14/2020 12:23 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/14/2020 12:23 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1588663769	9/14/2020 12:23 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/14/2020 12:23 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1538545520 ( )		9/14/2020 12:23 PM
Details	Last Recertification Date	Update	Recertification	8/26/2019 1:22:10 PM	9/14/2020 12:23:03 PM	9/14/2020 12:23 PM
Addresses	Shipping Address	Insert	Change Request		Kaweah Delta Health Care District 400 W. Mineral King Ave Visalia, CA 93291	11/6/2019 7:28 AM
Addresses	Billing Address	Update	Change Request	Kaweah Delta Health Care District 400 E Mineral King AVe Visalia, CA 93291	Kaweah Delta Health Care District 400 W Mineral King Ave Visalia, CA 93291	10/16/2019 2:54 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 5:29:43 PM	8/26/2019 1:22:10 PM	8/26/2019 1:22 PM
Contacts	Authorizing Official	Update	Profile Change Request	HERBST, GARY K. SR VP/CFO Kaweah Delta Health Care District 5596242496	HERBST, GARY K. Chief Executive Officer Kaweah Delta Health Care District 5596242330	1/19/2019 8:26 PM
Contacts	Signed By	Update	Profile Change Request	HERBST, GARY K. SR VP/CFO Kaweah Delta Health Care District 5596242496	HERBST, GARY K. Chief Executive Officer Kaweah Delta Health Care District 5596242330	1/19/2019 8:26 PM
Details	Last Recertification Date	Update	Recertification		8/20/2018 5:29:43 PM	8/20/2018 5:29 PM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		HERBST, GARY K. SR VP/CFO Kaweah Delta Health Care District 5596242496	10/18/2017 9:38 AM
Details	340B ID	Update	New Registration		DSH050057AC	10/18/2017 9:38 AM
Details	Entity Subname	Update	New Registration	KAWEAH DELTA CHRNC DIS MGMT	KAWEAH DELTA CHRNC DIS MGMT - Chronic Disease Management Clinc	10/18/2017 9:38 AM
Dates	Participating Approval Date	Update	New Registration		10/18/2017 9:38:39 AM	10/18/2017 9:38 AM
Details	State	Update	New Registration	Pending	Approved	10/18/2017 9:38 AM
Dates	Signed By Date	Update	New Registration		10/10/2017 2:12:17 PM	10/18/2017 9:38 AM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	10/18/2017 9:38 AM
Addresses	Main Address	Insert	New Registration		325 S. WILLIS STREET VISALIA, CA 93291-6105	10/10/2017 12:19 PM
Addresses	Billing Address	Insert	New Registration		Kaweah Delta Health Care District 400 E Mineral King AVe Visalia, CA 93291	10/10/2017 12:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2017 12:19 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1588663769	10/10/2017 12:19 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	10/10/2017 12:19 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538545520	10/10/2017 12:19 PM
Contacts	Authorizing Official	Insert	New Registration		HERBST, GARY K. SR VP/CFO Kaweah Delta Health Care District 5596242496	10/10/2017 12:19 PM
Contacts	Primary Contact	Insert	New Registration		Abercrombie, Catherine Pharmacy Business Coordinator Kaweah Delta Health Care District 5596244529	10/10/2017 12:19 PM
Details	Last Recertification Date	Insert	New Registration			10/10/2017 12:19 PM
Details	Grant Number	Insert	New Registration			10/10/2017 12:19 PM
Details	340B ID	Insert	New Registration			10/10/2017 12:19 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/10/2017 12:19 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/10/2017 12:19 PM
Details	Medicare Provider Number	Insert	New Registration		050057	10/10/2017 12:19 PM
Details	Entity Name	Insert	New Registration		KAWEAH DELTA HEALTH CARE DISTRICT	10/10/2017 12:19 PM
Details	Program Code	Insert	New Registration		DSH	10/10/2017 12:19 PM
Details	Entity Subname	Insert	New Registration		KAWEAH DELTA CHRNC DIS MGMT	10/10/2017 12:19 PM
Dates	Participating Approval Date	Insert	New Registration			10/10/2017 12:19 PM
Details	State	Insert	New Registration		Pending	10/10/2017 12:19 PM
Dates	Registration Date	Insert	New Registration		10/10/2017 12:19:51 PM	10/10/2017 12:19 PM
Dates	Signed By Date	Insert	New Registration			10/10/2017 12:19 PM
Dates	Start Date	Insert	New Registration			10/10/2017 12:19 PM
Terminations	Termination Comments	Insert	New Registration			10/10/2017 12:19 PM
Terminations	Termination Date	Insert	New Registration			10/10/2017 12:19 PM
Terminations	Termination Effective Date	Insert	New Registration			10/10/2017 12:19 PM
Terminations	Termination Reason	Insert	New Registration			10/10/2017 12:19 PM