Covered Entity Details

CAH051336-03 Southern Monterey County Memorial Hospital DBA: George L. Mee Memorial Hospital (Active) - information as of 5/13/2025 10:54:10 PM

Main Details

Name

Southern Monterey County Memorial Hospital DBA: George L. Mee Memorial Hospital

Subdivision Name

G L Mee Memorial Hospital - King City Clinic

Type

Critical Access Hospital

Rural

340B ID

CAH051336-03

Medicare Provider Number

051336

Outpatient Facility Provider Number

058562

Additional Details

Current Program Status

Active

Registration Date

10/13/2020

Participating Start Date

1/1/2021

Participating Approval Date

12/3/2020

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Mee Memorial Hospital
Rena Salamacha, CEO
(831) 385-7284

Primary Contact

Mee Memorial Hospital
Jason Lashbrook, Pharmacy Manager
(831) 385-7143

Addresses

Street Address

210 Canal Street
King City, CA 93930

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		1285685743

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
CAH051336-01	Child	CAH	Southern Monterey County Memorial Hospital DBA: George L. Mee Memorial Hospital	G L Mee Memorial Hospital - Dialysis	809 Broadway	King City	CA	Terminated
CAH051336-02	Child	CAH	Southern Monterey County Memorial Hospital DBA: George L. Mee Memorial Hospital	G L Mee Memorial Hospital - Greenfield Clinic	467 El Camino Real	Greenfield	CA	Active
CAH051336-03	Child	CAH	Southern Monterey County Memorial Hospital DBA: George L. Mee Memorial Hospital	G L Mee Memorial Hospital - King City Clinic	210 Canal Street	King City	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/31/2023 6:07:41 PM	8/14/2024 9:39:12 AM	8/14/2024 9:39 AM
Details	Last Recertification Date	Update	Recertification	8/30/2022 9:41:15 AM	8/31/2023 6:07:41 PM	8/31/2023 6:07 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 10:34:01 AM	8/30/2022 9:41:15 AM	8/30/2022 9:41 AM
Details	Last Recertification Date	Update	Recertification		8/23/2021 10:34:01 AM	8/23/2021 10:34 AM
Details	State	Update		Approved	Active	1/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Salamacha, Rena CEO Mee Memorial Hospital 8313857284	12/3/2020 7:58 AM
Details	340B ID	Update	New Registration		CAH051336-03	12/3/2020 7:58 AM
Details	Entity Subname	Update	New Registration	G L Mee Memorial Hospital	G L Mee Memorial Hospital - King City Clinic	12/3/2020 7:58 AM
Dates	Participating Approval Date	Update	New Registration		12/3/2020 7:58:06 AM	12/3/2020 7:58 AM
Details	State	Update	New Registration	Pending	Approved	12/3/2020 7:58 AM
Dates	Signed By Date	Update	New Registration		11/26/2020 8:18:52 AM	12/3/2020 7:58 AM
Dates	Start Date	Update	New Registration		1/1/2021 12:00:00 AM	12/3/2020 7:58 AM
Addresses	Main Address	Insert	New Registration		210 Canal Street King City, CA 93930	10/13/2020 3:44 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285685743	10/13/2020 3:44 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	10/13/2020 3:44 PM
Contacts	Primary Contact	Insert	New Registration		Lashbrook, Jason Pharmacy Manager Mee Memorial Hospital 8313857143	10/13/2020 3:44 PM
Contacts	Authorizing Official	Insert	New Registration		Salamacha, Rena CEO Mee Memorial Hospital 8313857284	10/13/2020 3:44 PM
Details	Assistance Received From Date	Insert	New Registration			10/13/2020 3:44 PM
Details	Assistance Received To Date	Insert	New Registration			10/13/2020 3:44 PM
Details	Last Recertification Date	Insert	New Registration			10/13/2020 3:44 PM
Details	Grant Number	Insert	New Registration			10/13/2020 3:44 PM
Details	340B ID	Insert	New Registration			10/13/2020 3:44 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/13/2020 3:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/13/2020 3:44 PM
Details	Medicare Provider Number	Insert	New Registration		051336	10/13/2020 3:44 PM
Details	Entity Name	Insert	New Registration		Southern Monterey County Memorial Hospital DBA: George L. Mee Memorial Hospital	10/13/2020 3:44 PM
Details	NOFO Number	Insert	New Registration			10/13/2020 3:44 PM
Details	Program Code	Insert	New Registration		CAH	10/13/2020 3:44 PM
Details	Entity Subname	Insert	New Registration		G L Mee Memorial Hospital	10/13/2020 3:44 PM
Dates	Participating Approval Date	Insert	New Registration			10/13/2020 3:44 PM
Details	State	Insert	New Registration		Pending	10/13/2020 3:44 PM
Dates	Registration Date	Insert	New Registration		10/13/2020 3:44:11 PM	10/13/2020 3:44 PM
Dates	Signed By Date	Insert	New Registration			10/13/2020 3:44 PM
Dates	Start Date	Insert	New Registration			10/13/2020 3:44 PM
Terminations	Termination Comments	Insert	New Registration			10/13/2020 3:44 PM
Terminations	Termination Date	Insert	New Registration			10/13/2020 3:44 PM
Terminations	Termination Effective Date	Insert	New Registration			10/13/2020 3:44 PM
Terminations	Termination Reason	Insert	New Registration			10/13/2020 3:44 PM