| Details | Last Recertification Date | Update | Recertification | 1/31/2024 1:06:19 PM | 2/24/2025 12:12:48 PM | 2/24/2025 12:12 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 11:12:34 AM | 1/31/2024 1:06:19 PM | 1/31/2024 1:06 PM |
| Addresses | Billing Address | Insert | Recertification | | Hi-Desert Memorial Health Care District
6530 La Contenta Rd
Suite 100
Yucca Valley, CA 92284 | 1/30/2023 11:12 AM |
| Details | Last Recertification Date | Update | Recertification | 2/18/2022 4:10:45 PM | 1/30/2023 11:12:34 AM | 1/30/2023 11:12 AM |
| Details | Entity Name | Update | Recertification | Hi-desert Memorial Health Care District | Hi-Desert Memorial Health Care District | 1/30/2023 11:12 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2021 5:36:30 PM | 2/18/2022 4:10:45 PM | 2/18/2022 4:10 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Combs, Jacqueline
EXECUTIVE DIRECTOR
Hi-Desert Memorial Health Care Distsrict
7608209229 | Schmall, Cindy
Chief Executive Officer
Hi-Desert Memorial Healthcare District
7608209229-1907 | 2/18/2022 11:56 AM |
| Contacts | Primary Contact | Update | OPA Edit | Schmall, Cindy
Chief Executive Officer
Hi-Desert Memorial Healthcare District
7608209229-1907 | Anderson, Deborah
CFO
Hi Desert Memorial Healthcare District
7608209232 | 2/15/2022 9:23 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Schmall, Cindy
Director of Operations
Hi-Desert Memorial Healthcare District
7608209229 | Schmall, Cindy
Chief Executive Officer
Hi-Desert Memorial Healthcare District
7608209229-1907 | 2/10/2022 7:48 PM |
| Details | Last Recertification Date | Update | Recertification | 2/10/2020 11:43:41 AM | 2/4/2021 5:36:30 PM | 2/4/2021 5:36 PM |
| Addresses | Main Address | Update | Recertification |
57463 Twentynine Palms Hwy, STE 202
Yucca Valley, CA 92284 |
58383 29 Palms Highway
Suite 101
Yucca Valley, CA 92284 | 2/10/2020 11:43 AM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 9:38:33 PM | 2/10/2020 11:43:41 AM | 2/10/2020 11:43 AM |
| Details | Entity Subname | Update | Recertification | Morongo Basin CHC Yucca Valley Airway | Morongo Basin Community Health Center - BH | 2/10/2020 11:43 AM |
| Contacts | Primary Contact | Update | Recertification | Stewart, Ronald A.
Executive Director
HI-Desert Family Health Clinic
7603666120 | Schmall, Cindy
Director of Operations
Hi-Desert Memorial Healthcare District
7608209229 | 1/29/2019 9:38 PM |
| Details | Last Recertification Date | Update | Recertification | | 1/29/2019 9:38:33 PM | 1/29/2019 9:38 PM |
| Details | State | Update | | Approved | Active | 4/1/2018 12:00 AM |
| Contacts | Signed By | Insert | New Registration | | Combs, Jacqueline
EXECUTIVE DIRECTOR
Hi-Desert Memorial Health Care Distsrict
7608209229 | 1/9/2018 2:47 PM |
| Details | 340B ID | Update | New Registration | | CHC26610-03 | 1/9/2018 2:47 PM |
| Dates | Participating Approval Date | Update | New Registration | | 1/9/2018 2:47:08 PM | 1/9/2018 2:47 PM |
| Details | State | Update | New Registration | Pending | Approved | 1/9/2018 2:47 PM |
| Dates | Signed By Date | Update | New Registration | | 1/3/2018 7:24:45 PM | 1/9/2018 2:47 PM |
| Dates | Start Date | Update | New Registration | | 4/1/2018 12:00:00 AM | 1/9/2018 2:47 PM |
| Contacts | Primary Contact | Update | | Stewart, Ronald
Executive Director
HI-Desert Family Health Clinic
7603666120 | Stewart, Ronald A.
Executive Director
HI-Desert Family Health Clinic
7603666120 | 1/3/2018 8:04 PM |
| Addresses | Main Address | Insert | New Registration | |
57463 Twentynine Palms Hwy, STE 202
Yucca Valley, CA 92284 | 1/3/2018 7:24 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Combs, Jacqueline
EXECUTIVE DIRECTOR
Hi-Desert Memorial Health Care Distsrict
7608209229 | 1/3/2018 7:24 PM |
| Contacts | Primary Contact | Insert | New Registration | | Stewart, Ronald
Executive Director
HI-Desert Family Health Clinic
7603666120 | 1/3/2018 7:24 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Details | Grant Number | Insert | New Registration | | H80CS26610 | 1/3/2018 7:24 PM |
| Details | 340B ID | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Details | Entity Name | Insert | New Registration | | Hi-desert Memorial Health Care District | 1/3/2018 7:24 PM |
| Details | Program Code | Insert | New Registration | | CH | 1/3/2018 7:24 PM |
| Details | Entity Subname | Insert | New Registration | | Morongo Basin CHC Yucca Valley Airway | 1/3/2018 7:24 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Details | State | Insert | New Registration | | Pending | 1/3/2018 7:24 PM |
| Dates | Registration Date | Insert | New Registration | | 1/3/2018 7:24:42 PM | 1/3/2018 7:24 PM |
| Dates | Signed By Date | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Dates | Start Date | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Terminations | Termination Date | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 1/3/2018 7:24 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 1/3/2018 7:24 PM |