Covered Entity Details

DSH030013AX YUMA REGIONAL MEDICAL CENTER (Active) - information as of 4/24/2025 11:12:35 PM

Main Details

Name

YUMA REGIONAL MEDICAL CENTER

Subdivision Name

YRMC Foothills Walk-In Clinic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH030013AX

Medicare Provider Number

030013

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/12/2020

Participating Start Date

10/1/2020

Participating Approval Date

7/21/2020

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

Yuma Regional Medical Center
Vernon Moore, Chief Financial Officer
(928) 336-7015

Primary Contact

Yuma Regional Medical Center
Mark Jordan, Directory of Pharmacy
(928) 336-7815

Addresses

Street Address

11142 S Scottsdale Drive
70825-10208041-10203002
Yuma, AZ 85367

Billing Address

Yuma Regional Medical Center
C/O AP
2400 S Ave A
Yuma, AZ 85364

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	1194706655,1598993420	1194706655,1598993420
AZ	020264	1194706655,1598993420

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
DSH030013A	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Cancer Center - Medical Oncology	2375 S. Ridgeview Dr	Yuma	AZ	Active
DSH030013AA	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Health Clinics - Children's Rehab Services	2851 S. Ave B, Bldg. 25, Suite 2504	Yuma	AZ	Terminated
DSH030013AB	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Primary Care San Luis	845 E B St.	San Luis	AZ	Active
DSH030013AC	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Health Clinics - Pediatric Neurology	2851 S. Ave B, Bldg. 25, Suite 2504	Yuma	AZ	Terminated
DSH030013AD	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Specialty Clinics - EP Cardiology	1951 W. 25th Street, Ste. F	Yuma	AZ	Active
DSH030013AE	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC PRIMARY CARE WONG 70810 522001001 - YRMC PRIMARY CARE WONG	2851 S Avenue B Bldg. 25	Yuma	AZ	Terminated
DSH030013AF	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YR PEDIATRICS ARORA 70950 10208005 - Pediatrics	2500 S 8TH AVE	Yuma	AZ	Terminated
DSH030013AG	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Pediatrics	2359 S. 22nd Drive, Suite 2	Yuma	AZ	Active
DSH030013AH	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC SPINE CLINIC 70790 59201001 - 59201001	2851 S Avenue B	Yuma	AZ	Terminated
DSH030013AJ	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Health Clinics - Pediatric Nephrology	2851 S. Ave B, Bldg. 25, Suite 2504	Yuma	AZ	Terminated
DSH030013AK	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMCPLZ SURGICAL SVC: 74210 - Outpatient Surgery	2460 S PARKVIEW LOOP	Yuma	AZ	Terminated
DSH030013AL	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Palliative Care	2451 S. Avenue A, Suite 104A	Yuma	AZ	Active
DSH030013AM	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Bone & Joint Tuscany Plaza	2851 S. Ave B, Bldg. 02, Suite 0201	Yuma	AZ	Active
DSH030013AN	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Specialty Clinics - Pulmonology	2851 S. Ave B, Bldg. 20, Suite 2001	Yuma	AZ	Active
DSH030013AP	Child	DSH	YUMA REGIONAL MEDICAL CENTER	Pediatric Cardiology:70990 - Cardiology	2851 S. Ave B, Bldg. 25,	YUma	AZ	Terminated
DSH030013AQ	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMCOC RHEUMATOLOGY: 70880 - RHEUMATOLOGY	2851 S AVENUE B,	Yuma	AZ	Terminated
DSH030013AR	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Pediatrics Tuscany	2851 S. Ave B, Bldg. 25	Yuma	AZ	Active
DSH030013AS	Child	DSH	YUMA REGIONAL MEDICAL CENTER	Pediatric Urology: 70920 - Urology	2851 S. Ave B, Bldg. 25,	Yuma	AZ	Terminated
DSH030013AT	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Health Clinics - Pediatric GI	2851 S. Ave B, Bldg. 25, Suite 2504	YUma	AZ	Terminated
DSH030013AU	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Ear, Nose and Throat	2680 S Ave B	Yuma	AZ	Active
DSH030013AV	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Plastic & Reconstructive Surgery	2460 S. Parkview Loop, Suite 201	YUma	AZ	Active
DSH030013AW	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Family Medicine West 24th St. Plaza	1965 W 24th Street, Suite A	YUma	AZ	Active
DSH030013AX	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Foothills Walk-In Clinic	11142 S Scottsdale Drive	Yuma	AZ	Active
DSH030013AY	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Foot and Ankle	1881 W 24th St, Suite C	Yuma	AZ	Active
DSH030013AZ	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Plaza Mammography	2460 S. Parkview Loop #2	Yuma	AZ	Terminated
DSH030013B	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Outpatient Surgery Center	2460 S. Parkview Loop Suite 1	Yuma	AZ	Active
DSH030013BA	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Women's Health Center	2911 S 8th Ave	YUMA	AZ	Active
DSH030013BB	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Women's Health Tuscany Plaza	2851 S. Ave B, Bldg. 06, Suite 0601	YUMA	AZ	Active
DSH030013BC	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Specialty Clinics - Neurology - YRMC Specialty Clinics - Neurology	2851 S. Ave B, Bldg. 20, Suite 2001	Yuma	AZ	Active
DSH030013BD	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC General Surgery - Vascular - YRMC General Surgery - Vascular	2270 S. Ridgeview Drive, Suite 201	Yuma	AZ	Active
DSH030013BE	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC General Surgery - YRMC General Surgery	2270 S. Ridgeview Drive, Suite 201	Yuma	AZ	Active
DSH030013BF	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Surgical Specialties - Urology - YRMC Surgical Specialties - Urology	2270 S. Ridgeview Drive, Suite 302	Yuma	AZ	Active
DSH030013BG	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Gastroenterology - YRMC Gastroenterology	1390 W. 16th Street	Yuma	AZ	Active
DSH030013BH	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Endoscopy Center - YRMC Endoscopy Center	2261 S. Avenue B	Yuma	AZ	Active
DSH030013BJ	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Internal Medicine & Diabetes - YRMC Internal Medicine & Diabetes	3800 W. 24th Street, Suite 1	Yuma	AZ	Active
DSH030013BK	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Outpatient Center - CT SCAN - PET CT	1320 W. 24th Street	Yuma	AZ	Active
DSH030013BL	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC FHC Foot and Ankle - Podiatry	11351 S. Frontage Road	Yuma	AZ	Active
DSH030013BM	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC FHC Pediatrics - Pediatrics	11351 S. Frontage Road	Yuma	AZ	Active
DSH030013BN	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC FHC Primary Care - Primary Care	11351 S. Frontage Road	Yuma	AZ	Active
DSH030013BP	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC FHC Anticoagulation - Anticoagulation and Medication Therapy Management	11351 S. Frontage Road	Yuma	AZ	Active
DSH030013BQ	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC FHC Women's Health - Women's Health	11351 S. Frontage Road	Yuma	AZ	Active
DSH030013BR	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC FHC Radiology - Diagnostic Imaging	11351 S. Frontage Road	Yuma	AZ	Active
DSH030013C	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Bariatric & General Surgery	2460 S. Parkview Loop, Suite 3	Yuma	AZ	Active
DSH030013D	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Wound Care Center	2460 S. Parkview Loop, Suite 205	Yuma	AZ	Active
DSH030013E	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Transitional Care Services	2451 S Ave A, Ste 104	Yuma	AZ	Active
DSH030013F	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Internal Medicine	2851 S. Ave B, Bldg. 25, Suite 2503	Yuma	AZ	Terminated
DSH030013G	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Outpatient Center	1320 W. 24th Street	Yuma	AZ	Active
DSH030013H	Child	DSH	YUMA REGIONAL MEDICAL CENTER	OB & Gynecology	845 B Street	San Luis	AZ	Terminated
DSH030013J	Child	DSH	YUMA REGIONAL MEDICAL CENTER	FAMILY MEDICINE CENTER 78700 10208005	2500 S 8th Avenue	Yuma	AZ	Terminated
DSH030013K	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Specialty Clinics - Rheumatology	2851 S. Ave B, Bldg. 20, Suite 2001	Yuma	AZ	Active
DSH030013L	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Ophthalmology	2270 S. Ridgeview Drive, Suite 303	Yuma	AZ	Active
DSH030013M	Child	DSH	YUMA REGIONAL MEDICAL CENTER	Perinatology	2851 S Avenue B, Bldg 20	Yuma	AZ	Terminated
DSH030013N	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Behavioral Health East	7200 E. 31st Place	Yuma	AZ	Active
DSH030013P	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Family Medicine Center	2500 S. 8th Ave, Suite 200	Yuma	AZ	Active
DSH030013Q	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Specialty Clinics - Endocrinology	2851 S. Ave B, Bldg. 20, Suite 2001	Yuma	AZ	Active
DSH030013R	Child	DSH	YUMA REGIONAL MEDICAL CENTER	ENDOCRINE CLINIC	2851 S Avenue B, Bldg 20	Yuma	AZ	Terminated
DSH030013S	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Center for Bone & Joint Health	2460 S. Parkview Loop, Suite 3	Yuma	AZ	Active
DSH030013T	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Specialty Clinics - Allergy & Immunology	2851 S. Ave B, Bldg. 20, Suite 2001	Yuma	AZ	Active
DSH030013U	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Cardiovascular & Thoracic Surgery	2460 S. Parkview Loop, Suite 203	Yuma	AZ	Active
DSH030013V	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Cardiology	1951 W. 25th Street, Ste. F	Yuma	AZ	Active
DSH030013W	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC HEALTH SERVICES 80110 10208026	2851 S Avenue B, Bldg 25	Yuma	AZ	Terminated
DSH030013X	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Anticoagulation Clinic - Kachina	2451 S. Avenue A	Yuma	AZ	Active
DSH030013Y	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Cancer Center - Radiation Oncology	2375 Ridgeview Dr	Yuma	AZ	Active
DSH030013Z	Child	DSH	YUMA REGIONAL MEDICAL CENTER	YRMC Health Clinics - Peds Endocrinology	2851 S. Ave B, Bldg. 25, Suite 2504	Yuma	AZ	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 1:56:51 PM	8/22/2024 2:56:07 PM	8/22/2024 2:56 PM
Details	Entity Subname	Update	Change Request	YRMC Primary Care Foothills	YRMC Foothills Walk-In Clinic	10/18/2023 1:26 PM
Details	Last Recertification Date	Update	Recertification	8/24/2022 1:36:21 PM	8/17/2023 1:56:51 PM	8/17/2023 1:56 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 4:52:02 PM	8/24/2022 1:36:21 PM	8/24/2022 1:36 PM
Contacts	Authorizing Official	Update	AO Change Request	Willie, David CFO Yuma Regional Medical Center 9283367015	Moore, Vernon Chief Financial Officer Yuma Regional Medical Center 9283367015	8/16/2022 7:23 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1194706655 ( )		8/30/2021 4:52 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1598993420 ( )		8/30/2021 4:52 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194706655	8/30/2021 4:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/30/2021 4:52 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598993420	8/30/2021 4:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/30/2021 4:52 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1194706655	8/30/2021 4:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/30/2021 4:52 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598993420	8/30/2021 4:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/30/2021 4:52 PM
Details	Last Recertification Date	Update	Recertification		8/30/2021 4:52:02 PM	8/30/2021 4:52 PM
Addresses	Main Address	Update	Change Request	11142 S Scottsdale Dr Yuma, AZ 85367	11142 S Scottsdale Drive 70825-10208041-10203002 Yuma, AZ 85367	5/21/2021 6:36 AM
Contacts	Primary Contact	Update	Change Request	Konopko, Martin 340b Manager Yuma Regional Medical Center 9283367721	Jordan, Mark Directory of Pharmacy Yuma Regional Medical Center 9283367815	5/21/2021 6:36 AM
Details	Entity Subname	Update	Change Request	YRMCFH PRIMARY CARE: 70825 - Primary Care	YRMC Primary Care Foothills	5/21/2021 6:36 AM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Willie, David CFO Yuma Regional Medical Center 9283367015	7/21/2020 3:58 PM
Details	340B ID	Update	New Registration		DSH030013AX	7/21/2020 3:58 PM
Details	Entity Subname	Update	New Registration	YRMCFH PRIMARY CARE: 70825	YRMCFH PRIMARY CARE: 70825 - Primary Care	7/21/2020 3:58 PM
Dates	Participating Approval Date	Update	New Registration		7/21/2020 3:58:17 PM	7/21/2020 3:58 PM
Details	State	Update	New Registration	Pending	Approved	7/21/2020 3:58 PM
Dates	Signed By Date	Update	New Registration		7/14/2020 8:06:46 PM	7/21/2020 3:58 PM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	7/21/2020 3:58 PM
Addresses	Main Address	Insert	New Registration		11142 S Scottsdale Dr Yuma, AZ 85367	7/12/2020 6:28 PM
Addresses	Billing Address	Insert	New Registration		Yuma Regional Medical Center C/O AP 2400 S Ave A Yuma, AZ 85364	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1194706655	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1598993420	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		020264	7/12/2020 6:28 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AZ	7/12/2020 6:28 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194706655	7/12/2020 6:28 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1598993420	7/12/2020 6:28 PM
Contacts	Primary Contact	Insert	New Registration		Konopko, Martin 340b Manager Yuma Regional Medical Center 9283367721	7/12/2020 6:28 PM
Contacts	Authorizing Official	Insert	New Registration		Willie, David CFO Yuma Regional Medical Center 9283367015	7/12/2020 6:28 PM
Details	Last Recertification Date	Insert	New Registration			7/12/2020 6:28 PM
Details	Grant Number	Insert	New Registration			7/12/2020 6:28 PM
Details	340B ID	Insert	New Registration			7/12/2020 6:28 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/12/2020 6:28 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/12/2020 6:28 PM
Details	Medicare Provider Number	Insert	New Registration		030013	7/12/2020 6:28 PM
Details	Entity Name	Insert	New Registration		YUMA REGIONAL MEDICAL CENTER	7/12/2020 6:28 PM
Details	Program Code	Insert	New Registration		DSH	7/12/2020 6:28 PM
Details	Entity Subname	Insert	New Registration		YRMCFH PRIMARY CARE: 70825	7/12/2020 6:28 PM
Dates	Participating Approval Date	Insert	New Registration			7/12/2020 6:28 PM
Details	State	Insert	New Registration		Pending	7/12/2020 6:28 PM
Dates	Registration Date	Insert	New Registration		7/12/2020 6:28:04 PM	7/12/2020 6:28 PM
Dates	Signed By Date	Insert	New Registration			7/12/2020 6:28 PM
Dates	Start Date	Insert	New Registration			7/12/2020 6:28 PM
Terminations	Termination Comments	Insert	New Registration			7/12/2020 6:28 PM
Terminations	Termination Date	Insert	New Registration			7/12/2020 6:28 PM
Terminations	Termination Effective Date	Insert	New Registration			7/12/2020 6:28 PM
Terminations	Termination Reason	Insert	New Registration			7/12/2020 6:28 PM