340B Drug Pricing Program Database


DSH050394F CMH OF SAN BUENAVENTURA (Active) - information as of 5/29/2025 2:00:04 AM

Main Details
CMH OF SAN BUENAVENTURA
San Buenaventura Urology Center - Urology
Disproportionate Share Hospital
No
DSH050394F
050394


Additional Details
Active
10/4/2019
1/1/2020
11/24/2019
8/12/2024

Contacts

Community Memorial Health System
James A Corwin, Chief Financial Officer
(805) 948-5003

Community Memorial Health System
Jacek Tretko, Director of Pharmacy Services
(805) 652-5068

Addresses

2705 Loma Vista Road
206
Ventura, CA 93003-1584

Community Memorial Health System
147 N Brent St
Ventura, CA 93003


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA 1730498411,1215903018
Shipping Addresses

Community Memorial Hospital Ventura
147 N Brent St
Ventura, CA 93003
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050394AChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Main Street - Primary Care138 W Main StreetVenturaCAActive
DSH050394BChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Vineyard - Primary Care2361 E Vineyard AvenueOxnardCAActive
DSH050394CChildDSHCMH OF SAN BUENAVENTURACMH Midtown Medical Group - Primary Care2721 E Main StreetVenturaCAActive
DSH050394DChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Fillmore - Primary Care852 W Ventura RoadFillmoreCAActive
DSH050394EChildDSHCMH OF SAN BUENAVENTURASanta Rosa Health Clinic - Primary Care5800 Santa Rosa RoadCamarilloCAActive
DSH050394FChildDSHCMH OF SAN BUENAVENTURASan Buenaventura Urology Center - Urology2705 Loma Vista RoadVenturaCAActive
DSH050394GChildDSHCMH OF SAN BUENAVENTURAPremier Health Center - Primary Care258 E Harvard BlvdSanta PaulaCAActive
DSH050394HChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Saviers - Primary Care2921 Saviers RoadOxnardCAActive
DSH050394JChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Ashwood - Primary Care120 N Ashwood DriveVenturaCAActive
DSH050394KChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Santa Paula - Primary Care242 E Harvard BlvdSanta PaulaCAActive
DSH050394LChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Camarillo - Primary Care422 Arneill RoadCamarilloCAActive
DSH050394MChildDSHCMH OF SAN BUENAVENTURACMH Same Day Surgery - Outpatient Surgery168 N Brent StreetVenturaCAActive
DSH050394NChildDSHCMH OF SAN BUENAVENTURACMH Midtown Medical Group - Specialty Clinic168 N Brent StreetVenturaCAActive
DSH050394PChildDSHCMH OF SAN BUENAVENTURACenter for Wound Care - Wound Care2705 Loma Vista RoadVenturaCAActive
DSH050394QChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Airport - Primary Care3641 W 5th StreetOxnardCAActive
DSH050394RChildDSHCMH OF SAN BUENAVENTURACMH Centers for Family Health-Port Hueneme - Primary Care321 E Port Hueneme RoadPort HuenemeCAActive
DSH050394SChildDSHCMH OF SAN BUENAVENTURACentral Coast Center for Gynecological Oncology - Gynecology/Oncology2900 Loma Vista RoadVenturaCAActive
DSH050394TChildDSHCMH OF SAN BUENAVENTURACMH Midtown Medical Group - Pediatrics - Pediatric3655 W 5th StreetOxnardCAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberInsertGroup Change Request 121590301811/27/2024 3:43 PM
Medicaid BillingNPI: StateInsertGroup Change Request CA11/27/2024 3:43 PM
ContactsPrimary ContactUpdateProfile Change RequestTretko, Jacek Director of Outpatient Pharmacy and Purchasing Community Memorial Health System 8056525068Tretko, Jacek Director of Pharmacy Services Community Memorial Health System 805652506811/26/2024 12:41 PM
DetailsLast Recertification DateUpdateRecertification8/18/2023 3:45:54 PM8/12/2024 8:15:34 PM8/12/2024 8:15 PM
DetailsLast Recertification DateUpdateRecertification8/24/2022 6:06:27 PM8/18/2023 3:45:54 PM8/18/2023 3:45 PM
DetailsLast Recertification DateUpdateRecertification8/17/2021 5:26:48 PM8/24/2022 6:06:27 PM8/24/2022 6:06 PM
AddressesBilling AddressUpdateChange RequestCommunity Memorial Health System 5855 Olivas Park Drive Ventura, CA 93003Community Memorial Health System 147 N Brent St Ventura, CA 930036/22/2022 8:55 AM
AddressesShipping AddressInsertChange Request Community Memorial Hospital Ventura 147 N Brent St Ventura, CA 930036/22/2022 8:55 AM
ContactsPrimary ContactUpdateGroup Change RequestDay, Eugene Luke Director of Pharmacy Services Community Memorial Health System 8056525069Tretko, Jacek Director of Outpatient Pharmacy and Purchasing Community Memorial Health System 805652506811/16/2021 2:55 PM
DetailsLast Recertification DateUpdateRecertification9/1/2020 11:22:15 AM8/17/2021 5:26:48 PM8/17/2021 5:26 PM
ContactsAuthorizing OfficialUpdateAO Change RequestGLYER, DAVID BURRIS cfo Community Memorial Health System 8056525003Corwin, James A Chief Financial Officer Community Memorial Health System 805948500312/7/2020 8:05 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/1/2020 11:22 AM
DetailsLast Recertification DateUpdateRecertification 9/1/2020 11:22:15 AM9/1/2020 11:22 AM
DetailsStateUpdate ApprovedActive1/1/2020 12:04 AM
ContactsSigned ByInsertNew Registration GLYER, DAVID BURRIS cfo Community Memorial Health System 805652500311/24/2019 6:11 PM
Details340B IDUpdateNew Registration DSH050394F11/24/2019 6:11 PM
DetailsEntity SubnameUpdateNew RegistrationSan Buenaventura Urology CenterSan Buenaventura Urology Center - Urology11/24/2019 6:11 PM
DatesParticipating Approval DateUpdateNew Registration 11/24/2019 6:11:47 PM11/24/2019 6:11 PM
DetailsStateUpdateNew RegistrationPendingApproved11/24/2019 6:11 PM
DatesSigned By DateUpdateNew Registration 10/4/2019 8:07:14 PM11/24/2019 6:11 PM
DatesStart DateUpdateNew Registration 1/1/2020 12:00:00 AM11/24/2019 6:11 PM
AddressesMain AddressInsertNew Registration  2705 Loma Vista Road 206 Ventura, CA 93003-158410/4/2019 8:07 PM
AddressesBilling AddressInsertNew Registration Community Memorial Health System 5855 Olivas Park Drive Ventura, CA 9300310/4/2019 8:07 PM
Medicaid BillingNPI: NumberInsertNew Registration 173049841110/4/2019 8:07 PM
ContactsPrimary ContactInsertNew Registration Day, Eugene Luke Director of Pharmacy Services Community Memorial Health System 805652506910/4/2019 8:07 PM
ContactsAuthorizing OfficialInsertNew Registration GLYER, DAVID BURRIS cfo Community Memorial Health System 805652500310/4/2019 8:07 PM
DetailsLast Recertification DateInsertNew Registration  10/4/2019 8:07 PM
DetailsGrant NumberInsertNew Registration  10/4/2019 8:07 PM
Details340B IDInsertNew Registration  10/4/2019 8:07 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/4/2019 8:07 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/4/2019 8:07 PM
DetailsMedicare Provider NumberInsertNew Registration 05039410/4/2019 8:07 PM
DetailsEntity NameInsertNew Registration CMH OF SAN BUENAVENTURA10/4/2019 8:07 PM
DetailsProgram CodeInsertNew Registration DSH10/4/2019 8:07 PM
DetailsEntity SubnameInsertNew Registration San Buenaventura Urology Center10/4/2019 8:07 PM
DatesParticipating Approval DateInsertNew Registration  10/4/2019 8:07 PM
DetailsStateInsertNew Registration Pending10/4/2019 8:07 PM
DatesRegistration DateInsertNew Registration 10/4/2019 8:07:12 PM10/4/2019 8:07 PM
DatesSigned By DateInsertNew Registration  10/4/2019 8:07 PM
DatesStart DateInsertNew Registration  10/4/2019 8:07 PM
TerminationsTermination CommentsInsertNew Registration  10/4/2019 8:07 PM
TerminationsTermination DateInsertNew Registration  10/4/2019 8:07 PM
TerminationsTermination Effective DateInsertNew Registration  10/4/2019 8:07 PM
TerminationsTermination ReasonInsertNew Registration  10/4/2019 8:07 PM