Covered Entity Details

DSH050315D KERN MEDICAL CENTER (Active) - information as of 5/25/2025 10:17:32 PM

Main Details

Name

KERN MEDICAL CENTER

Subdivision Name

KERN COUNTY HOSPITAL AUTHORITY - PEDIATRICS CLINIC

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050315D

Medicare Provider Number

050315

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/12/2019

Participating Start Date

7/1/2019

Participating Approval Date

4/22/2019

Last Recertification Date

8/13/2024

Contacts

Authorizing Official

Kern Medical Center
Scott Thygerson, Chief Executive Officer
(661) 326-2102

Primary Contact

Kern Medical
Jeffrey Charles Jolliff, Director of Pharmacy
(661) 326-2191

Addresses

Street Address

1111 COLUMBUS STREET
1000
BAKERSFIELD, CA 93305

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	HSC30315W	1427176569,1376623538,1629081849,1699859223

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
DSH050315A	Child	DSH	KERN MEDICAL CENTER	SAGEBRUSH MEDICAL CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Terminated
DSH050315C	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - OBGYN CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315D	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - PEDIATRICS CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315E	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - MEDICINE CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315F	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - COLUMBUS INFUSION CENTER	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315G	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - FAMILY PRACTICE CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active
DSH050315H	Child	DSH	KERN MEDICAL CENTER	KERN COUNTY HOSPITAL AUTHORITY - MEDICINE SPECIALTY CLINIC	1111 COLUMBUS STREET	BAKERSFIELD	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/16/2023 10:56:49 AM	8/13/2024 10:39:50 AM	8/13/2024 10:39 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 10:45:47 AM	8/16/2023 10:56:49 AM	8/16/2023 10:56 AM
Contacts	Primary Contact	Update	Recertification	Joson, Jeremiah Associate Director of Pharmacy Kern Medical Center 6613265682	Jolliff, Jeffrey Charles Director of Pharmacy Kern Medical 6613262191	8/29/2022 10:45 AM
Details	Last Recertification Date	Update	Recertification	8/27/2021 11:26:49 AM	8/29/2022 10:45:47 AM	8/29/2022 10:45 AM
Contacts	Authorizing Official	Update	AO Change Request	Judd, Russell V Chief Executive Officer Kern Medical Center 6613262102	Thygerson, Scott Chief Executive Officer Kern Medical Center 6613262102	12/8/2021 7:40 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 6:51:49 PM	8/27/2021 11:26:49 AM	8/27/2021 11:26 AM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:51 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:51 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:51 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/18/2020 6:51 PM
Details	Last Recertification Date	Update	Recertification	8/29/2019 11:51:28 AM	8/18/2020 6:51:49 PM	8/18/2020 6:51 PM
Details	Last Recertification Date	Update	Recertification		8/29/2019 11:51:28 AM	8/29/2019 11:51 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Judd, Russell V Chief Executive Officer Kern Medical Center 6613262102	4/22/2019 10:44 AM
Details	340B ID	Update	New Registration		DSH050315D	4/22/2019 10:44 AM
Details	Entity Subname	Update	New Registration	KERN COUNTY HOSPITAL AUTHORITY	KERN COUNTY HOSPITAL AUTHORITY - PEDIATRICS CLINIC	4/22/2019 10:44 AM
Dates	Participating Approval Date	Update	New Registration		4/22/2019 10:44:52 AM	4/22/2019 10:44 AM
Details	State	Update	New Registration	Pending	Approved	4/22/2019 10:44 AM
Dates	Signed By Date	Update	New Registration		4/18/2019 5:22:54 PM	4/22/2019 10:44 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	4/22/2019 10:44 AM
Contacts	Authorizing Official	Update	Profile Change Request	Judd, Russell V Chief Executive Officer Kern Medical 6613262102	Judd, Russell V Chief Executive Officer Kern Medical Center 6613262102	4/15/2019 12:49 PM
Contacts	Primary Contact	Update	Profile Change Request	Joson, Jeremiah Associate Director of Pharmacy Kern Medical c 6613265682	Joson, Jeremiah Associate Director of Pharmacy Kern Medical Center 6613265682	4/15/2019 12:27 PM
Contacts	Primary Contact	Update	Profile Change Request	Joson, Jeremiah Associate Director of Pharmacy Kern Medical 6613265682	Joson, Jeremiah Associate Director of Pharmacy Kern Medical c 6613265682	4/15/2019 12:27 PM
Addresses	Main Address	Insert	New Registration		1111 COLUMBUS STREET 1000 BAKERSFIELD, CA 93305	4/12/2019 4:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2019 4:31 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HSC30315W	4/12/2019 4:31 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	4/12/2019 4:31 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427176569	4/12/2019 4:31 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376623538	4/12/2019 4:31 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629081849	4/12/2019 4:31 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1699859223	4/12/2019 4:31 PM
Contacts	Primary Contact	Insert	New Registration		Joson, Jeremiah Associate Director of Pharmacy Kern Medical 6613265682	4/12/2019 4:31 PM
Contacts	Authorizing Official	Insert	New Registration		Judd, Russell V Chief Executive Officer Kern Medical 6613262102	4/12/2019 4:31 PM
Details	Last Recertification Date	Insert	New Registration			4/12/2019 4:31 PM
Details	Grant Number	Insert	New Registration			4/12/2019 4:31 PM
Details	340B ID	Insert	New Registration			4/12/2019 4:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2019 4:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2019 4:31 PM
Details	Medicare Provider Number	Insert	New Registration		050315	4/12/2019 4:31 PM
Details	Entity Name	Insert	New Registration		KERN MEDICAL CENTER	4/12/2019 4:31 PM
Details	Program Code	Insert	New Registration		DSH	4/12/2019 4:31 PM
Details	Entity Subname	Insert	New Registration		KERN COUNTY HOSPITAL AUTHORITY	4/12/2019 4:31 PM
Dates	Participating Approval Date	Insert	New Registration			4/12/2019 4:31 PM
Details	State	Insert	New Registration		Pending	4/12/2019 4:31 PM
Dates	Registration Date	Insert	New Registration		4/12/2019 4:31:08 PM	4/12/2019 4:31 PM
Dates	Signed By Date	Insert	New Registration			4/12/2019 4:31 PM
Dates	Start Date	Insert	New Registration			4/12/2019 4:31 PM
Terminations	Termination Comments	Insert	New Registration			4/12/2019 4:31 PM
Terminations	Termination Date	Insert	New Registration			4/12/2019 4:31 PM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2019 4:31 PM
Terminations	Termination Reason	Insert	New Registration			4/12/2019 4:31 PM