Covered Entity Details

CAH051333-15 Ridgecrest Regional Hospital (Active) - information as of 6/17/2025 11:42:03 PM

Main Details

Name

Ridgecrest Regional Hospital

Subdivision Name

RH- Specialty Clinic

Type

Critical Access Hospital

Rural

340B ID

CAH051333-15

Medicare Provider Number

051333

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/10/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/13/2020

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Ridgecrest Regional Hospital
James Suver, CEO
(760) 499-3902

Primary Contact

Ridgecrest Regional Hospital760-499-3185
Margie Rose, Program Director
(415) 564-9856

Addresses

Street Address

1111 N. China Lake Blvd.
Ridgecrest, CA 93555

Billing Address

Ridgecrest Regional Hospital
1081 N. China Lake Blvd.
Ridgecrest, CA 93555

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	1447253125	1972813087,1790811289,1447253125

Shipping Addresses

Shipping Address 1

Ridgecrest Regional Hospital
1081 N. China Lake Blvd.
Ridgecrest, CA 93555

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
CAH051333-01	Child	CAH	Ridgecrest Regional Hospital	RH Primary Care Clinic	1111 N. China Lake Blvd.	Ridgecrest	CA	Active
CAH051333-02	Child	CAH	Ridgecrest Regional Hospital	RHC VI-Community Care Health Clinic	1041 N. China Lake Blvd.	Ridgecrest	CA	Active
CAH051333-03	Child	CAH	Ridgecrest Regional Hospital	RHC VI-Gastroenterology Clinic	1041 N. China Lake Blvd	Ridgecrest	CA	Active
CAH051333-04	Child	CAH	Ridgecrest Regional Hospital	RHC VI-Surgery Clinic	1011 N. China Lake Blvd.	Ridgecrest	CA	Active
CAH051333-05	Child	CAH	Ridgecrest Regional Hospital	RHC VI-Orthopedic Clinic	1041 N. China Lake Blvd	Ridgecrest	CA	Active
CAH051333-06	Child	CAH	Ridgecrest Regional Hospital	RH-Urgent Care	1111 N. China Lake Blvd	Ridgecrest	CA	Active
CAH051333-07	Child	CAH	Ridgecrest Regional Hospital	RH-Mental Clinic	1111 N. China Lake Blvd.	Ridgecrest	CA	Active
CAH051333-08	Child	CAH	Ridgecrest Regional Hospital	RHC II- Trona Clinic	82820 TRONA ROAD	TRONA	CA	Active
CAH051333-09	Child	CAH	Ridgecrest Regional Hospital	Outpatient Services	1011 N. China Lake Blvd.	Ridgecrest	CA	Active
CAH051333-10	Child	CAH	Ridgecrest Regional Hospital	RH- Dental Clinic	1111 N China Lake Blvd	Ridgecrest	CA	Active
CAH051333-11	Child	CAH	Ridgecrest Regional Hospital	RH- Pediatrics Clinic	1111 N China Lake Blvd., Suite 301	Ridgecrest	CA	Active
CAH051333-12	Child	CAH	Ridgecrest Regional Hospital	RHC III- Womens Health Clinic	1011 N China Lake Blvd	Ridgecrest	CA	Active
CAH051333-13	Child	CAH	Ridgecrest Regional Hospital	RRH- Cancer Clinic	1011 N China Lake Blvd Suite A	Ridgecrest	CA	Terminated
CAH051333-14	Child	CAH	Ridgecrest Regional Hospital	RHC VI-Podiatry Clinic	1041 N China Lake Blvd.	Ridgecrest	CA	Active
CAH051333-15	Child	CAH	Ridgecrest Regional Hospital	RH- Specialty Clinic	1111 N. China Lake Blvd.	Ridgecrest	CA	Active
CAH051333-16	Child	CAH	Ridgecrest Regional Hospital	RHC V - SSMC Primary Clinic	105 E Syndor Ave.	Ridgecrest	CA	Active
CAH051333-17	Child	CAH	Ridgecrest Regional Hospital	RHC V- Pain Clinic	105 E Syndor Ave.	Ridgecrest	CA	Active
CAH051333-18	Child	CAH	Ridgecrest Regional Hospital	RHC IV- Mobile Clinic	1111 N. China Lake Blvd	Ridgecrest	CA	Active
CAH051333-19	Child	CAH	Ridgecrest Regional Hospital	RHC V- Urology Clinic	105 E Sydnor Ave.	Ridgecrest	CA	Active
CAH051333-20	Child	CAH	Ridgecrest Regional Hospital	RHC V- Dermatology Clinic	105 E Syndor Ave.	Ridgecrest	CA	Active
CAH051333-21	Child	CAH	Ridgecrest Regional Hospital	RHC-II Visiting Nurses Services	82820 Trona Road	Trona	CA	Active
CAH051333-22	Child	CAH	Ridgecrest Regional Hospital	Ambulatory Surgery Center - Surgery Center	1111 N China Lake Blvd Ste 220	Ridgecrest	CA	Terminated
CAH051333-23	Child	CAH	Ridgecrest Regional Hospital	RHC VI-China Lake Comm HC - Health Clinic	1041 N China Lake Blvd	Ridgecrest	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	1111 N. China Lake Blvd., Suite 501 Ridgecrest, CA 93555	1111 N. China Lake Blvd. Ridgecrest, CA 93555	6/13/2025 7:56 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 12:25:34 AM	8/15/2024 1:02:24 PM	8/15/2024 1:02 PM
Contacts	Authorizing Official	Update	Change Request	Mills, Celia Mary Administrator of Care Coordination and Community Health Ridgecrest Regional Hospital 7604993960	Suver, James CEO Ridgecrest Regional Hospital 7604993902	7/5/2024 1:56 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 2:30:58 PM	8/16/2023 12:25:34 AM	8/16/2023 12:25 AM
Contacts	Primary Contact	Update	Profile Change Request	Rose, Margie Innovation Manager Ridgecrest Regional Hospital 7604993185	Rose, Margie Program Director Ridgecrest Regional Hospital760-499-3185 4155649856	8/4/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1447253125	12/22/2022 4:37 PM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/22/2022 4:37 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1730544313 (CA)		12/12/2022 1:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1972813087 (CA)		12/12/2022 1:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1720352685 (CA)		12/12/2022 1:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1639448400 (CA)		12/12/2022 1:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1679038434 (CA)		12/12/2022 1:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1407231210 (CA)		12/12/2022 1:17 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1790811289 (CA)		12/12/2022 1:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1447253125 (CA)		12/12/2022 1:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1730544313 (CA)		12/12/2022 1:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1720352685 (CA)		12/12/2022 1:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1639448400 (CA)		12/12/2022 1:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1679038434 (CA)		12/12/2022 1:17 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1407231210 (CA)		12/12/2022 1:17 PM
Details	Entity Subname	Update	Change Request	Rural Health Clinic Specialty - Cardiology	RH- Specialty Clinic	10/4/2022 7:22 AM
Details	Last Recertification Date	Update	Recertification	9/1/2021 1:37:32 PM	8/29/2022 2:30:58 PM	8/29/2022 2:30 PM
Contacts	Authorizing Official	Update	Change Request	Suver, James CEO Ridgecrest Regional Hospital 7604993902	Mills, Celia Mary Administrator of Care Coordination and Community Health Ridgecrest Regional Hospital 7604993960	1/26/2022 7:03 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 7:32:22 AM	9/1/2021 1:37:32 PM	9/1/2021 1:37 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1447253125	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1730544313	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1972813087	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1720352685	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1639448400	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1679038434	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1407231210	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1790811289	12/14/2020 10:36 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1447253125	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1730544313	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1972813087	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1720352685	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1639448400	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1679038434	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1407231210	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790811289	12/14/2020 10:36 AM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/14/2020 10:36 AM
Addresses	Main Address	Update	Recertification	1111 N. China Lake Blvd., Suite 201 Ridgecrest, CA 93555	1111 N. China Lake Blvd., Suite 501 Ridgecrest, CA 93555	9/11/2020 7:32 AM
Addresses	Shipping Address	Insert	Recertification		Ridgecrest Regional Hospital 1081 N. China Lake Blvd. Ridgecrest, CA 93555	9/11/2020 7:32 AM
Details	Last Recertification Date	Update	Recertification		9/11/2020 7:32:22 AM	9/11/2020 7:32 AM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Suver, James CEO Ridgecrest Regional Hospital 7604993902	4/13/2020 12:48 PM
Details	340B ID	Update	New Registration		CAH051333-15	4/13/2020 12:48 PM
Details	Entity Name	Update	New Registration	RIDGECREST REGIONAL HOSPITAL	Ridgecrest Regional Hospital	4/13/2020 12:48 PM
Details	Entity Subname	Update	New Registration	Rural Health Clinic Specialty	Rural Health Clinic Specialty - Cardiology	4/13/2020 12:48 PM
Dates	Participating Approval Date	Update	New Registration		4/13/2020 12:48:30 PM	4/13/2020 12:48 PM
Details	State	Update	New Registration	Pending	Approved	4/13/2020 12:48 PM
Dates	Signed By Date	Update	New Registration		4/10/2020 5:35:52 PM	4/13/2020 12:48 PM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/13/2020 12:48 PM
Addresses	Main Address	Insert	New Registration		1111 N. China Lake Blvd., Suite 201 Ridgecrest, CA 93555	4/10/2020 5:18 PM
Addresses	Billing Address	Insert	New Registration		Ridgecrest Regional Hospital 1081 N. China Lake Blvd. Ridgecrest, CA 93555	4/10/2020 5:18 PM
Contacts	Authorizing Official	Insert	New Registration		Suver, James CEO Ridgecrest Regional Hospital 7604993902	4/10/2020 5:18 PM
Contacts	Primary Contact	Insert	New Registration		Rose, Margie Innovation Manager Ridgecrest Regional Hospital 7604993185	4/10/2020 5:18 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2020 5:18 PM
Details	Grant Number	Insert	New Registration			4/10/2020 5:18 PM
Details	340B ID	Insert	New Registration			4/10/2020 5:18 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2020 5:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2020 5:18 PM
Details	Medicare Provider Number	Insert	New Registration		051333	4/10/2020 5:18 PM
Details	Entity Name	Insert	New Registration		RIDGECREST REGIONAL HOSPITAL	4/10/2020 5:18 PM
Details	Program Code	Insert	New Registration		CAH	4/10/2020 5:18 PM
Details	Entity Subname	Insert	New Registration		Rural Health Clinic Specialty	4/10/2020 5:18 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2020 5:18 PM
Details	State	Insert	New Registration		Pending	4/10/2020 5:18 PM
Dates	Registration Date	Insert	New Registration		4/10/2020 5:18:25 PM	4/10/2020 5:18 PM
Dates	Signed By Date	Insert	New Registration			4/10/2020 5:18 PM
Dates	Start Date	Insert	New Registration			4/10/2020 5:18 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2020 5:18 PM
Terminations	Termination Date	Insert	New Registration			4/10/2020 5:18 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2020 5:18 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2020 5:18 PM