Covered Entity Details

DSH050100AH SHARP MEMORIAL HOSPITAL (Active) - information as of 6/9/2025 11:04:49 PM

Main Details

Name

SHARP MEMORIAL HOSPITAL

Subdivision Name

Heart Transplant Clinic - Post Heart Transplant-O/P

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050100AH

Medicare Provider Number

050100

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/11/2018

Participating Start Date

4/1/2018

Participating Approval Date

2/8/2018

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Sharp HealthCare
Tony Guerra, Chief Financial Officer
(858) 939-4090

Primary Contact

Sharp HealthCare
Zephyr T Skeets, 340B Specialist
(858) 499-2148

Addresses

Street Address

3075 Health Center Dr.
Suite 101
SAN DIEGO, CA 92123

Billing Address
Same as Street Address

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		1407839921

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
DSH050100AA	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Downtown Senior Health Center	956 Tenth Ave	San Diego	CA	Terminated
DSH050100AB	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Home Care Services	8080 Dagget St	San Diego	CA	Terminated
DSH050100AC	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - C/S Surgery	3003 Health Center Dr	San Diego	CA	Active
DSH050100AD	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - C/S Surgery	3075 Health Center Dr	San Diego	CA	Active
DSH050100AE	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - O/P Imaging	3075 Health Center Dr	San Diego	CA	Active
DSH050100AF	Child	DSH	SHARP MEMORIAL HOSPITAL	Outpatient Pavilion / Diabetes Clinic	3075 Health Center Dr	San Diego	CA	Active
DSH050100AG	Child	DSH	SHARP MEMORIAL HOSPITAL	Rehabilitation / Outpatient Clinic	2999 Health Center Dr	San Diego	CA	Active
DSH050100AH	Child	DSH	SHARP MEMORIAL HOSPITAL	Heart Transplant Clinic - Post Heart Transplant-O/P	3075 Health Center Dr.	SAN DIEGO	CA	Active
DSH050100AJ	Child	DSH	SHARP MEMORIAL HOSPITAL	Kidney Transplant Clinic - Post Kidney Transplant-O/P	8010 Frost Street	San Diego	CA	Active
DSH050100AK	Child	DSH	SHARP MEMORIAL HOSPITAL	Pancreas Transplant Clinic - Post Pancreas Transplant-O/P	8010 Frost Street	San Diego	CA	Active
DSH050100AL	Child	DSH	SHARP MEMORIAL HOSPITAL	SHARP MEMORIAL HOSPITAL - Nemeth NICU Follow Up Clinic	8010 Frost Street	San Diego	CA	Active
DSH050100B	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns	3003 Health Center Drive	San Diego	CA	Terminated
DSH050100C	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Women's Surgery	3003 Health Center Dr	San Diego	CA	Active
DSH050100D	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Women's Recovery	3003 Health Center Dr	San Diego	CA	Active
DSH050100E	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Surgical Recovery (PACU)	3003 Health Center Dr	San Diego	CA	Active
DSH050100F	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - O/P Surgery Center	3003 Health Center Dr	San Diego	CA	Active
DSH050100G	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Triage/Urgent Care	3003 Health Center Dr	San Diego	CA	Active
DSH050100H	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Maternal & Fetal	3003 Health Center Dr	San Diego	CA	Active
DSH050100J	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Lactation	3003 Health Center Dr	San Diego	CA	Active
DSH050100K	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Labor & Delivery	3003 Health Center Dr	San Diego	CA	Active
DSH050100L	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Radiology Diagnostic	3003 Health Center Dr	San Diego	CA	Active
DSH050100M	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Respiratory Therapy	3003 Health Center Dr	San Diego	CA	Active
DSH050100N	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Mary Birch Hospital for Women and Newborns - Newborn Hearing Screening	3003 Health Center Dr	San Diego	CA	Active
DSH050100P	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - O/P Surgery Center	3075 Health Center Dr	San Diego	CA	Active
DSH050100Q	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Endoscopy	3075 Health Center Dr	San Diego	CA	Active
DSH050100R	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Radiology Diagnostic	3075 Health Center Dr	San Diego	CA	Active
DSH050100S	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - PET Scanner	3075 Health Center Dr	San Diego	CA	Active
DSH050100T	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Radiation Therapy	3075 Health Center Dr	San Diego	CA	Active
DSH050100U	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - CT Scan	3075 Health Center Dr	San Diego	CA	Active
DSH050100V	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Ultrasound	3075 Health Center Dr	San Diego	CA	Active
DSH050100W	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - O/P Infusion Clinic	8010 Frost Street	San Diego	CA	Active
DSH050100X	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp Memorial Outpatient Pavilion - Ophthalmology	3075 Health Center Dr	San Diego	CA	Terminated
DSH050100Y	Child	DSH	SHARP MEMORIAL HOSPITAL	Heart Transplant/Mechanical Circulatory Support Clinic	3075 Health Center Dr.	San Diego	CA	Active
DSH050100Z	Child	DSH	SHARP MEMORIAL HOSPITAL	Sharp-Clairemont Senior Health Center	4320 Genesee Ave	San Diego	CA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 7:55:34 AM	8/12/2024 11:43:50 AM	8/12/2024 11:43 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1114901352 (CA)		8/29/2023 7:55 AM
Contacts	Primary Contact	Update	Recertification	Sachs, Susan System Pharmacy Manager Sharp HealthCare 8584994220	Skeets, Zephyr T 340B Specialist Sharp HealthCare 8584992148	8/29/2023 7:55 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 2:13:30 PM	8/29/2023 7:55:34 AM	8/29/2023 7:55 AM
Contacts	Authorizing Official	Update	Change Request	SMITH, TIM CEO Sharp Memorial Hospital 8589394082	Guerra, Tony Chief Financial Officer Sharp HealthCare 8589394090	2/17/2023 1:34 PM
Details	Last Recertification Date	Update	Recertification	8/25/2021 2:14:11 PM	9/7/2022 2:13:30 PM	9/7/2022 2:13 PM
Details	Last Recertification Date	Update	Recertification	8/21/2020 11:53:54 AM	8/25/2021 2:14:11 PM	8/25/2021 2:14 PM
Details	Last Recertification Date	Update	Recertification	9/12/2019 4:26:31 PM	8/21/2020 11:53:54 AM	8/21/2020 11:53 AM
Medicaid Billing	NPI: State	Update	Change Request		CA	8/14/2020 12:31 PM
Medicaid Billing	NPI: State	Update	Change Request		CA	8/14/2020 12:31 PM
Contacts	Primary Contact	Update	Change Request	Flores, Besher 340B Program Specialist Sharp Healthcare 8584994678	Sachs, Susan System Pharmacy Manager Sharp HealthCare 8584994220	8/14/2020 12:31 PM
Details	Last Recertification Date	Update	Recertification	9/6/2018 5:43:51 PM	9/12/2019 4:26:31 PM	9/12/2019 4:26 PM
Details	Last Recertification Date	Update	Recertification		9/6/2018 5:43:51 PM	9/6/2018 5:43 PM
Addresses	Main Address	Update	Change Request	3131 Berger Ave. 110 SAN DIEGO, CA 92123	3075 Health Center Dr. Suite 101 SAN DIEGO, CA 92123	4/12/2018 9:46 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		SMITH, TIM CEO Sharp Memorial Hospital 8589394082	2/8/2018 12:02 PM
Details	340B ID	Update	New Registration		DSH050100AH	2/8/2018 12:02 PM
Details	Entity Subname	Update	New Registration	Heart Transplant Clinic	Heart Transplant Clinic - Post Heart Transplant-O/P	2/8/2018 12:02 PM
Dates	Participating Approval Date	Update	New Registration		2/8/2018 12:02:09 PM	2/8/2018 12:02 PM
Details	State	Update	New Registration	Pending	Approved	2/8/2018 12:02 PM
Dates	Signed By Date	Update	New Registration		1/11/2018 12:43:05 PM	2/8/2018 12:02 PM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	2/8/2018 12:02 PM
Addresses	Main Address	Insert	New Registration		3131 Berger Ave. 110 SAN DIEGO, CA 92123	1/11/2018 9:10 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1407839921	1/11/2018 9:10 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1114901352	1/11/2018 9:10 AM
Contacts	Primary Contact	Insert	New Registration		Flores, Besher 340B Program Specialist Sharp Healthcare 8584994678	1/11/2018 9:10 AM
Contacts	Authorizing Official	Insert	New Registration		SMITH, TIM CEO Sharp Memorial Hospital 8589394082	1/11/2018 9:10 AM
Details	Last Recertification Date	Insert	New Registration			1/11/2018 9:10 AM
Details	Grant Number	Insert	New Registration			1/11/2018 9:10 AM
Details	340B ID	Insert	New Registration			1/11/2018 9:10 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2018 9:10 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2018 9:10 AM
Details	Medicare Provider Number	Insert	New Registration		050100	1/11/2018 9:10 AM
Details	Entity Name	Insert	New Registration		SHARP MEMORIAL HOSPITAL	1/11/2018 9:10 AM
Details	Program Code	Insert	New Registration		DSH	1/11/2018 9:10 AM
Details	Entity Subname	Insert	New Registration		Heart Transplant Clinic	1/11/2018 9:10 AM
Dates	Participating Approval Date	Insert	New Registration			1/11/2018 9:10 AM
Details	State	Insert	New Registration		Pending	1/11/2018 9:10 AM
Dates	Registration Date	Insert	New Registration		1/11/2018 9:10:16 AM	1/11/2018 9:10 AM
Dates	Signed By Date	Insert	New Registration			1/11/2018 9:10 AM
Dates	Start Date	Insert	New Registration			1/11/2018 9:10 AM
Terminations	Termination Comments	Insert	New Registration			1/11/2018 9:10 AM
Terminations	Termination Date	Insert	New Registration			1/11/2018 9:10 AM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2018 9:10 AM
Terminations	Termination Reason	Insert	New Registration			1/11/2018 9:10 AM