Covered Entity Details

CAH051337-01 HAZEL HAWKINS MEM. HOSPITAL (Active) - information as of 5/1/2025 11:52:18 PM

Main Details

Name

HAZEL HAWKINS MEM. HOSPITAL

Subdivision Name

Barragan Family Health Care and Diabetes Center - RHC

Type

Critical Access Hospital

Rural

340B ID

CAH051337-01

Medicare Provider Number

051337

Outpatient Facility Provider Number

058705

Additional Details

Current Program Status

Active

Registration Date

7/13/2021

Participating Start Date

10/1/2021

Participating Approval Date

7/20/2021

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

Hazel Hawkins Memorial Hospital
MARK ROBINSON, CFO
(831) 636-2604

Primary Contact

Hazel Hawkins Memorial Hospital
Sandra Dilaura, Controller
(831) 636-2659

Addresses

Street Address

930 Sunnyslope Rd, Suite A-2
Hollister, CA 95023

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?
No

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
CAH051337-01	Child	CAH	HAZEL HAWKINS MEM. HOSPITAL	Barragan Family Health Care and Diabetes Center - RHC	930 Sunnyslope Rd, Suite A-2	Hollister	CA	Active
CAH051337-02	Child	CAH	HAZEL HAWKINS MEM. HOSPITAL	Mabie First Street Healthcare Center - RHC	321 First Street	Hollister	CA	Active
CAH051337-03	Child	CAH	HAZEL HAWKINS MEM. HOSPITAL	Mabie San Juan Road Health Center - RHC	991 San Juan Road	Hollister	CA	Active
CAH051337-04	Child	CAH	HAZEL HAWKINS MEM. HOSPITAL	San Benito Community Health Clinic - RHC	930 Sunset Drive	Hollister	CA	Active
CAH051337-05	Child	CAH	HAZEL HAWKINS MEM. HOSPITAL	Hazel Hawkins Health Clinic - RHC	301 The Alameda Suite B-3	San Juan Bautista	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Recertification	Parnell, Lindsey Controller Hazel Hawkins Memorial Hospital 8316351138	Dilaura, Sandra Controller Hazel Hawkins Memorial Hospital 8316362659	8/19/2024 7:45 AM
Details	Last Recertification Date	Update	Recertification	8/24/2023 8:12:49 PM	8/19/2024 7:45:06 AM	8/19/2024 7:45 AM
Details	Last Recertification Date	Update	Recertification	8/30/2022 6:14:15 AM	8/24/2023 8:12:49 PM	8/24/2023 8:12 PM
Contacts	Primary Contact	Update	Recertification	Gambetta, Karen Controller Hazel Hawkins Memorial Hospital 8316351138	Parnell, Lindsey Controller Hazel Hawkins Memorial Hospital 8316351138	8/30/2022 6:14 AM
Details	Last Recertification Date	Update	Recertification		8/30/2022 6:14:15 AM	8/30/2022 6:14 AM
Details	State	Update		Approved	Active	10/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		ROBINSON, MARK CFO Hazel Hawkins Memorial Hospital 8316362604	7/20/2021 10:35 AM
Details	340B ID	Update	New Registration		CAH051337-01	7/20/2021 10:35 AM
Details	Entity Subname	Update	New Registration	Barragan Family Health Care and Diabetes Center	Barragan Family Health Care and Diabetes Center - RHC	7/20/2021 10:35 AM
Dates	Participating Approval Date	Update	New Registration		7/20/2021 10:35:38 AM	7/20/2021 10:35 AM
Details	State	Update	New Registration	Pending	Approved	7/20/2021 10:35 AM
Dates	Signed By Date	Update	New Registration		7/14/2021 7:11:46 PM	7/20/2021 10:35 AM
Dates	Start Date	Update	New Registration		10/1/2021 12:00:00 AM	7/20/2021 10:35 AM
Addresses	Main Address	Insert	New Registration		930 Sunnyslope Rd, Suite A-2 Hollister, CA 95023	7/13/2021 6:40 PM
Contacts	Authorizing Official	Insert	New Registration		ROBINSON, MARK CFO Hazel Hawkins Memorial Hospital 8316362604	7/13/2021 6:40 PM
Contacts	Primary Contact	Insert	New Registration		Gambetta, Karen Controller Hazel Hawkins Memorial Hospital 8316351138	7/13/2021 6:40 PM
Details	Assistance Received From Date	Insert	New Registration			7/13/2021 6:40 PM
Details	Assistance Received To Date	Insert	New Registration			7/13/2021 6:40 PM
Details	Last Recertification Date	Insert	New Registration			7/13/2021 6:40 PM
Details	Grant Number	Insert	New Registration			7/13/2021 6:40 PM
Details	340B ID	Insert	New Registration			7/13/2021 6:40 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2021 6:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2021 6:40 PM
Details	Medicare Provider Number	Insert	New Registration		051337	7/13/2021 6:40 PM
Details	Entity Name	Insert	New Registration		HAZEL HAWKINS MEM. HOSPITAL	7/13/2021 6:40 PM
Details	NOFO Number	Insert	New Registration			7/13/2021 6:40 PM
Details	Program Code	Insert	New Registration		CAH	7/13/2021 6:40 PM
Details	Entity Subname	Insert	New Registration		Barragan Family Health Care and Diabetes Center	7/13/2021 6:40 PM
Dates	Participating Approval Date	Insert	New Registration			7/13/2021 6:40 PM
Details	State	Insert	New Registration		Pending	7/13/2021 6:40 PM
Dates	Registration Date	Insert	New Registration		7/13/2021 6:40:08 PM	7/13/2021 6:40 PM
Dates	Signed By Date	Insert	New Registration			7/13/2021 6:40 PM
Dates	Start Date	Insert	New Registration			7/13/2021 6:40 PM
Terminations	Termination Comments	Insert	New Registration			7/13/2021 6:40 PM
Terminations	Termination Date	Insert	New Registration			7/13/2021 6:40 PM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2021 6:40 PM
Terminations	Termination Reason	Insert	New Registration			7/13/2021 6:40 PM