Yes
Community Memorial Hospital Ventura
147 N Brent St
Ventura, CA 93003
| DSH050394A | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Main Street - Primary Care | 138 W Main Street | Ventura | CA | Active |
| DSH050394B | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Vineyard - Primary Care | 2361 E Vineyard Avenue | Oxnard | CA | Active |
| DSH050394C | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Midtown Medical Group - Primary Care | 2721 E Main Street | Ventura | CA | Active |
| DSH050394D | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Fillmore - Primary Care | 852 W Ventura Road | Fillmore | CA | Active |
| DSH050394E | Child | DSH | CMH OF SAN BUENAVENTURA | Santa Rosa Health Clinic - Primary Care | 5800 Santa Rosa Road | Camarillo | CA | Active |
| DSH050394F | Child | DSH | CMH OF SAN BUENAVENTURA | San Buenaventura Urology Center - Urology | 2705 Loma Vista Road | Ventura | CA | Active |
| DSH050394G | Child | DSH | CMH OF SAN BUENAVENTURA | Premier Health Center - Primary Care | 258 E Harvard Blvd | Santa Paula | CA | Active |
| DSH050394H | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Saviers - Primary Care | 2921 Saviers Road | Oxnard | CA | Active |
| DSH050394J | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Ashwood - Primary Care | 120 N Ashwood Drive | Ventura | CA | Active |
| DSH050394K | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Santa Paula - Primary Care | 242 E Harvard Blvd | Santa Paula | CA | Active |
| DSH050394L | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Camarillo - Primary Care | 422 Arneill Road | Camarillo | CA | Active |
| DSH050394M | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Same Day Surgery - Outpatient Surgery | 168 N Brent Street | Ventura | CA | Active |
| DSH050394N | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Midtown Medical Group - Specialty Clinic | 168 N Brent Street | Ventura | CA | Active |
| DSH050394P | Child | DSH | CMH OF SAN BUENAVENTURA | Center for Wound Care - Wound Care | 2705 Loma Vista Road | Ventura | CA | Active |
| DSH050394Q | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Airport - Primary Care | 3641 W 5th Street | Oxnard | CA | Active |
| DSH050394R | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Centers for Family Health-Port Hueneme - Primary Care | 321 E Port Hueneme Road | Port Hueneme | CA | Active |
| DSH050394S | Child | DSH | CMH OF SAN BUENAVENTURA | Central Coast Center for Gynecological Oncology - Gynecology/Oncology | 2900 Loma Vista Road | Ventura | CA | Active |
| DSH050394T | Child | DSH | CMH OF SAN BUENAVENTURA | CMH Midtown Medical Group - Pediatrics - Pediatric | 3655 W 5th Street | Oxnard | CA | Active |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1215903018 | 11/27/2024 3:43 PM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | CA | 11/27/2024 3:43 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Tretko, Jacek
Director of Outpatient Pharmacy and Purchasing
Community Memorial Health System
8056525068 | Tretko, Jacek
Director of Pharmacy Services
Community Memorial Health System
8056525068 | 11/26/2024 12:41 PM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2023 3:45:54 PM | 8/12/2024 8:15:34 PM | 8/12/2024 8:15 PM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2022 6:06:27 PM | 8/18/2023 3:45:54 PM | 8/18/2023 3:45 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2021 5:26:48 PM | 8/24/2022 6:06:27 PM | 8/24/2022 6:06 PM |
| Addresses | Billing Address | Update | Change Request | Community Memorial Health System
5855 Olivas Park Drive
Ventura, CA 93003 | Community Memorial Health System
147 N Brent St
Ventura, CA 93003 | 6/22/2022 8:55 AM |
| Addresses | Shipping Address | Insert | Change Request | | Community Memorial Hospital Ventura
147 N Brent St
Ventura, CA 93003 | 6/22/2022 8:55 AM |
| Contacts | Primary Contact | Update | Group Change Request | Day, Eugene Luke
Director of Pharmacy Services
Community Memorial Health System
8056525069 | Tretko, Jacek
Director of Outpatient Pharmacy and Purchasing
Community Memorial Health System
8056525068 | 11/16/2021 2:55 PM |
| Details | Last Recertification Date | Update | Recertification | 9/1/2020 11:22:15 AM | 8/17/2021 5:26:48 PM | 8/17/2021 5:26 PM |
| Contacts | Authorizing Official | Update | AO Change Request | GLYER, DAVID BURRIS
cfo
Community Memorial Health System
8056525003 | Corwin, James A
Chief Financial Officer
Community Memorial Health System
8059485003 | 12/7/2020 8:05 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 9/1/2020 11:22 AM |
| Details | Last Recertification Date | Update | Recertification | | 9/1/2020 11:22:15 AM | 9/1/2020 11:22 AM |
| Details | State | Update | | Approved | Active | 1/1/2020 12:04 AM |
| Contacts | Signed By | Insert | New Registration | | GLYER, DAVID BURRIS
cfo
Community Memorial Health System
8056525003 | 11/24/2019 6:11 PM |
| Details | 340B ID | Update | New Registration | | DSH050394F | 11/24/2019 6:11 PM |
| Details | Entity Subname | Update | New Registration | San Buenaventura Urology Center | San Buenaventura Urology Center - Urology | 11/24/2019 6:11 PM |
| Dates | Participating Approval Date | Update | New Registration | | 11/24/2019 6:11:47 PM | 11/24/2019 6:11 PM |
| Details | State | Update | New Registration | Pending | Approved | 11/24/2019 6:11 PM |
| Dates | Signed By Date | Update | New Registration | | 10/4/2019 8:07:14 PM | 11/24/2019 6:11 PM |
| Dates | Start Date | Update | New Registration | | 1/1/2020 12:00:00 AM | 11/24/2019 6:11 PM |
| Addresses | Main Address | Insert | New Registration | |
2705 Loma Vista Road
206
Ventura, CA 93003-1584 | 10/4/2019 8:07 PM |
| Addresses | Billing Address | Insert | New Registration | | Community Memorial Health System
5855 Olivas Park Drive
Ventura, CA 93003 | 10/4/2019 8:07 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1730498411 | 10/4/2019 8:07 PM |
| Contacts | Primary Contact | Insert | New Registration | | Day, Eugene Luke
Director of Pharmacy Services
Community Memorial Health System
8056525069 | 10/4/2019 8:07 PM |
| Contacts | Authorizing Official | Insert | New Registration | | GLYER, DAVID BURRIS
cfo
Community Memorial Health System
8056525003 | 10/4/2019 8:07 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Details | Grant Number | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Details | 340B ID | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 050394 | 10/4/2019 8:07 PM |
| Details | Entity Name | Insert | New Registration | | CMH OF SAN BUENAVENTURA | 10/4/2019 8:07 PM |
| Details | Program Code | Insert | New Registration | | DSH | 10/4/2019 8:07 PM |
| Details | Entity Subname | Insert | New Registration | | San Buenaventura Urology Center | 10/4/2019 8:07 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Details | State | Insert | New Registration | | Pending | 10/4/2019 8:07 PM |
| Dates | Registration Date | Insert | New Registration | | 10/4/2019 8:07:12 PM | 10/4/2019 8:07 PM |
| Dates | Signed By Date | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Dates | Start Date | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Terminations | Termination Date | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 10/4/2019 8:07 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 10/4/2019 8:07 PM |