340B Drug Pricing Program Database


DSH050292G Riverside University Health System (Active) - information as of 6/13/2025 2:53:18 PM

Main Details
Riverside University Health System
RUHS - MEDICAL CENTER - RUH MSC PET-CT / 57-178720 - PET - CT
Disproportionate Share Hospital
Yes
DSH050292G
050292


Additional Details
Active
1/15/2021
4/1/2021
1/22/2021
8/29/2024

Contacts

RUHS
Leah Patterson, Chief Nursing Officer
(951) 486-7532

RUHS
Davalyn Tidwell, Pharmacy Director
(951) 486-4527

Addresses

26600 CACTUS AVE STE 100
MORENO VALLEY, CA 92555-3927

Same as Street Address


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

Yes
StateMedicaid NumberNPI Number
CAPHOE331201730216607,1386852416,1083794580,1225248644,1821159195
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050292CChildDSHRiverside University Health SystemMH ER Treatment Facility/ETS (Behavioral Health/Mental Health)9990 County Farm RoadRiversideCAActive
DSH050292DChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC SURGERY CLINIC / 90-17078126600 CACTUS AVEMORENO VALLEYCAActive
DSH050292EChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC ORTHOPEDICS CLINIC / 90-17076126600 CACTUS AVEMORENO VALLEYCAActive
DSH050292FChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC Mammography-Diagno Imaging / 54-176321 - MAMMO-DIAG26600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292GChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC PET-CT / 57-178720 - PET - CT26600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292HChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC OPERATING ROOM / 50-174201 - OPERATING ROOM26600 CACTUS AVE STE 200MORENO VALLEYCAActive
DSH050292JChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC FAMILY CARE / 90-170880 - FAMILY CARE26600 CACTUS AVE STE 100MORENO VALLEYCATerminated
DSH050292KChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC Cardiopulnry Rehab&Wellnes / 69-175931 - CARDIOPULMONARY REHAB26600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292LChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC MRI-DIAGNOSTIC / 58-176601 - MRI-DIAGNOSTICS26600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292MChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH Geriatric / 90-174100 - GERIATRICS26600 CACTUS AVE STE 100MORENO VALLEYCATerminated
DSH050292NChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC Ultrasound-Diagnos Imaging / 54-176701 - ULTRASOUND26600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292PChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC Nuclear Med Diagno Imaging / 56-176511 - NUCLEAR MED26600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292QChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC Diagnostic Imaging / 54-176301 - DIAGNOSTIC IMAGING26600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292RChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC Physical Therapy - Physical Therapy / 66-17770126600 CACTUS AVE STE 100MORENO VALLEYCAActive
DSH050292SChildDSHRiverside University Health SystemRUHS - MEDICAL CENTER - RUH MSC Echocardiology - Echocardiology / 69-17560126600 CACTUS AVE STE 100Moreno ValleyCAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/7/2023 3:32:43 PM8/29/2024 2:30:15 PM8/29/2024 2:30 PM
DetailsLast Recertification DateUpdateRecertification9/13/2022 4:46:27 PM9/7/2023 3:32:43 PM9/7/2023 3:32 PM
DetailsLast Recertification DateUpdateRecertification9/3/2021 10:29:09 AM9/13/2022 4:46:27 PM9/13/2022 4:46 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestPatterson, Leah Chief Nursing Officer RUHS 9514864665Patterson, Leah Chief Nursing Officer RUHS 95148675322/8/2022 4:24 PM
ContactsSigned ByUpdateProfile Change RequestPatterson, Leah Chief Nursing Officer RUHS 9514864665Patterson, Leah Chief Nursing Officer RUHS 95148675322/8/2022 4:24 PM
DetailsLast Recertification DateUpdateRecertification 9/3/2021 10:29:09 AM9/3/2021 10:29 AM
DetailsStateUpdate ApprovedActive4/1/2021 12:01 AM
ContactsSigned ByInsertNew Registration Patterson, Leah Chief Nursing Officer RUHS 95148646651/22/2021 11:11 AM
Details340B IDUpdateNew Registration DSH050292G1/22/2021 11:11 AM
DetailsEntity SubnameUpdateNew RegistrationRUHS - MEDICAL CENTER - RUH MSC PET-CT / 57-178720RUHS - MEDICAL CENTER - RUH MSC PET-CT / 57-178720 - PET - CT1/22/2021 11:11 AM
DatesParticipating Approval DateUpdateNew Registration 1/22/2021 11:11:15 AM1/22/2021 11:11 AM
DetailsStateUpdateNew RegistrationPendingApproved1/22/2021 11:11 AM
DatesSigned By DateUpdateNew Registration 1/15/2021 8:01:11 PM1/22/2021 11:11 AM
DatesStart DateUpdateNew Registration 4/1/2021 12:00:00 AM1/22/2021 11:11 AM
AddressesMain AddressInsertNew Registration  26600 CACTUS AVE STE 100 MORENO VALLEY, CA 92555-39271/15/2021 7:54 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/15/2021 7:54 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHOE331201/15/2021 7:54 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA1/15/2021 7:54 PM
Medicaid BillingNPI: NumberInsertNew Registration 18211591951/15/2021 7:54 PM
Medicaid BillingNPI: StateInsertNew Registration CA1/15/2021 7:54 PM
Medicaid BillingNPI: NumberInsertNew Registration 10837945801/15/2021 7:54 PM
Medicaid BillingNPI: StateInsertNew Registration CA1/15/2021 7:54 PM
Medicaid BillingNPI: NumberInsertNew Registration 17302166071/15/2021 7:54 PM
Medicaid BillingNPI: StateInsertNew Registration CA1/15/2021 7:54 PM
Medicaid BillingNPI: NumberInsertNew Registration 13868524161/15/2021 7:54 PM
Medicaid BillingNPI: StateInsertNew Registration CA1/15/2021 7:54 PM
Medicaid BillingNPI: NumberInsertNew Registration 12252486441/15/2021 7:54 PM
Medicaid BillingNPI: StateInsertNew Registration CA1/15/2021 7:54 PM
ContactsPrimary ContactInsertNew Registration Tidwell, Davalyn Pharmacy Director RUHS 95148645271/15/2021 7:54 PM
ContactsAuthorizing OfficialInsertNew Registration Patterson, Leah Chief Nursing Officer RUHS 95148646651/15/2021 7:54 PM
DetailsAssistance Received From DateInsertNew Registration  1/15/2021 7:54 PM
DetailsAssistance Received To DateInsertNew Registration  1/15/2021 7:54 PM
DetailsLast Recertification DateInsertNew Registration  1/15/2021 7:54 PM
DetailsGrant NumberInsertNew Registration  1/15/2021 7:54 PM
Details340B IDInsertNew Registration  1/15/2021 7:54 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/15/2021 7:54 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/15/2021 7:54 PM
DetailsMedicare Provider NumberInsertNew Registration 0502921/15/2021 7:54 PM
DetailsEntity NameInsertNew Registration Riverside University Health System1/15/2021 7:54 PM
DetailsNOFO NumberInsertNew Registration  1/15/2021 7:54 PM
DetailsProgram CodeInsertNew Registration DSH1/15/2021 7:54 PM
DetailsEntity SubnameInsertNew Registration RUHS - MEDICAL CENTER - RUH MSC PET-CT / 57-1787201/15/2021 7:54 PM
DatesParticipating Approval DateInsertNew Registration  1/15/2021 7:54 PM
DetailsStateInsertNew Registration Pending1/15/2021 7:54 PM
DatesRegistration DateInsertNew Registration 1/15/2021 7:54:00 PM1/15/2021 7:54 PM
DatesSigned By DateInsertNew Registration  1/15/2021 7:54 PM
DatesStart DateInsertNew Registration  1/15/2021 7:54 PM
TerminationsTermination CommentsInsertNew Registration  1/15/2021 7:54 PM
TerminationsTermination DateInsertNew Registration  1/15/2021 7:54 PM
TerminationsTermination Effective DateInsertNew Registration  1/15/2021 7:54 PM
TerminationsTermination ReasonInsertNew Registration  1/15/2021 7:54 PM