Covered Entity Details

DSH050082D ST JOHNS REGIONAL MEDICAL CENTER (Active) - information as of 4/25/2025 5:40:58 PM

Main Details

Name

ST JOHNS REGIONAL MEDICAL CENTER

Subdivision Name

Dignity Infusion Center Ventura - Dignity Infusion Center Ventura

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050082D

Medicare Provider Number

050082

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2017

Participating Start Date

1/1/2018

Participating Approval Date

10/20/2017

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

St. John's Regional Medical Center
Emma Grossman, VP, CFO
(805) 988-2754

Primary Contact

CommonSpirit Health
Ryan Pearcy, 340B Region Manager
(859) 229-5654

Addresses

Street Address

2900 Loma Vista Road
Suite 200
Ventura, CA 93003

Billing Address

Dignity Health AP
3033 North 3rd Avenue
Phoenix, AZ 85013

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	HSC30082G	1073665360

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
DSH050082A	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	Outpatient Surgery Center	1700 N. Rose Ave	Oxnard	CA	Active
DSH050082B	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	Dignity Infusion Center Oxnard - Dignity Infusion Center Oxnard	1700 North Rose Avenue	Oxnard	CA	Active
DSH050082C	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	Dignity Infusion Center Camarillo - Dignity Infusion Center Camarillo	500 Paseo Camarillo	Camarillo	CA	Active
DSH050082D	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	Dignity Infusion Center Ventura - Dignity Infusion Center Ventura	2900 Loma Vista Road	Ventura	CA	Active
DSH050082E	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - MAGNETIC RESONANCE IMAGING	2309 Antonio Ave	Camarillo	CA	Active
DSH050082F	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - SHORT STAY UNIT	2309 Antonio Ave	Camarillo	CA	Active
DSH050082G	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - HYPERBARIC CHAMBER SERVICES	2309 Antonio Ave	Camarillo	CA	Active
DSH050082H	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - CARDIAC CATHETERIZATION SVCS	2309 Antonio Ave	Camarillo	CA	Active
DSH050082J	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - WOUND CARE	2309 Antonio Ave	Camarillo	CA	Active
DSH050082K	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - RADIOLOGY-DIAGNOSTIC	2309 Antonio Ave	Camarillo	CA	Active
DSH050082L	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - SURGERY	2309 Antonio Ave	Camarillo	CA	Active
DSH050082M	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - ELECTRONEURODIAGNOSTICS	2309 Antonio Ave	Camarillo	CA	Active
DSH050082N	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - COMPUTED TOMOGRAPHIC SCANNER	2309 Antonio Ave	Camarillo	CA	Active
DSH050082P	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - NUCLEAR MEDICINE	2309 Antonio Ave	Camarillo	CA	Active
DSH050082Q	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - ANESTHESIOLOGY	2309 Antonio Ave	Camarillo	CA	Active
DSH050082R	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - GASTRO-INTESTINAL SERVICES	2309 Antonio Ave	Camarillo	CA	Active
DSH050082S	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - POST ANESTHESIA CARE UNIT	2309 Antonio Ave	Camarillo	CA	Active
DSH050082T	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - RESPIRATORY THERAPY	2309 Antonio Ave	Camarillo	CA	Active
DSH050082U	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - EMERGENCY SERVICES	2309 Antonio Ave	Camarillo	CA	Active
DSH050082V	Child	DSH	ST JOHNS REGIONAL MEDICAL CENTER	St. John's Hospital Camarillo - ULTRASONOGRAPHY	2309 Antonio Ave	Camarillo	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Richardson, Matt VP/CFO Service Area CFO CommonSpirit Health 8057393108	Grossman, Emma VP, CFO St. John's Regional Medical Center 8059882754	4/2/2025 3:21 PM
Contacts	Primary Contact	Update	Group Change Request	Olszewski, Lisa Ann 340B compliance pharmacist Dignity Health 8057393450	Pearcy, Ryan 340B Region Manager CommonSpirit Health 8592295654	3/25/2025 1:26 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 6:07:14 PM	8/19/2024 3:47:21 PM	8/19/2024 3:47 PM
Details	Last Recertification Date	Update	Recertification	8/25/2022 2:19:33 PM	8/14/2023 6:07:14 PM	8/14/2023 6:07 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 2:30:46 PM	8/25/2022 2:19:33 PM	8/25/2022 2:19 PM
Details	Last Recertification Date	Update	Recertification	8/28/2020 11:36:39 AM	8/17/2021 2:30:46 PM	8/17/2021 2:30 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073665360	8/28/2020 11:36 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/28/2020 11:36 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1073665360 ( )		8/28/2020 11:36 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 11:55:38 AM	8/28/2020 11:36:39 AM	8/28/2020 11:36 AM
Contacts	Primary Contact	Update	Change Request	Mulder, John 340B Compliance Pharmacist Marian Regional Medical Center 8057393450	Olszewski, Lisa Ann 340B compliance pharmacist Dignity Health 8057393450	1/3/2020 10:38 AM
Contacts	Authorizing Official	Update	Change Request	ANDERSEN, SUE CFO Dignity Health 8057393110	Richardson, Matt VP/CFO Service Area CFO CommonSpirit Health 8057393108	1/3/2020 10:36 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 12:28:27 AM	8/27/2019 11:55:38 AM	8/27/2019 11:55 AM
Details	Last Recertification Date	Update	Recertification		8/21/2018 12:28:27 AM	8/21/2018 12:28 AM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		ANDERSEN, SUE CFO Dignity Health 8057393110	10/20/2017 7:31 AM
Details	340B ID	Update	New Registration		DSH050082D	10/20/2017 7:31 AM
Details	Entity Subname	Update	New Registration	Dignity Infusion Center Ventura	Dignity Infusion Center Ventura - Dignity Infusion Center Ventura	10/20/2017 7:31 AM
Dates	Participating Approval Date	Update	New Registration		10/20/2017 7:31:35 AM	10/20/2017 7:31 AM
Details	State	Update	New Registration	Pending	Approved	10/20/2017 7:31 AM
Dates	Signed By Date	Update	New Registration		10/19/2017 1:07:13 PM	10/20/2017 7:31 AM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	10/20/2017 7:31 AM
Addresses	Main Address	Insert	New Registration		2900 Loma Vista Road Suite 200 Ventura, CA 93003	10/12/2017 1:34 PM
Addresses	Billing Address	Insert	New Registration		Dignity Health AP 3033 North 3rd Avenue Phoenix, AZ 85013	10/12/2017 1:34 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2017 1:34 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HSC30082G	10/12/2017 1:34 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	10/12/2017 1:34 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073665360	10/12/2017 1:34 PM
Contacts	Primary Contact	Insert	New Registration		Mulder, John 340B Compliance Pharmacist Marian Regional Medical Center 8057393450	10/12/2017 1:34 PM
Contacts	Authorizing Official	Insert	New Registration		ANDERSEN, SUE CFO Dignity Health 8057393110	10/12/2017 1:34 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2017 1:34 PM
Details	Grant Number	Insert	New Registration			10/12/2017 1:34 PM
Details	340B ID	Insert	New Registration			10/12/2017 1:34 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2017 1:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2017 1:34 PM
Details	Medicare Provider Number	Insert	New Registration		050082	10/12/2017 1:34 PM
Details	Entity Name	Insert	New Registration		ST JOHNS REGIONAL MEDICAL CENTER	10/12/2017 1:34 PM
Details	Program Code	Insert	New Registration		DSH	10/12/2017 1:34 PM
Details	Entity Subname	Insert	New Registration		Dignity Infusion Center Ventura	10/12/2017 1:34 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2017 1:34 PM
Details	State	Insert	New Registration		Pending	10/12/2017 1:34 PM
Dates	Registration Date	Insert	New Registration		10/12/2017 1:34:22 PM	10/12/2017 1:34 PM
Dates	Signed By Date	Insert	New Registration			10/12/2017 1:34 PM
Dates	Start Date	Insert	New Registration			10/12/2017 1:34 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2017 1:34 PM
Terminations	Termination Date	Insert	New Registration			10/12/2017 1:34 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2017 1:34 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2017 1:34 PM