Covered Entity Details

CAH051333-17 Ridgecrest Regional Hospital (Active) - information as of 5/13/2025 1:39:52 AM

Main Details

Name

Ridgecrest Regional Hospital

Subdivision Name

RHC V- Pain Clinic

Type

Critical Access Hospital

Rural

340B ID

CAH051333-17

Medicare Provider Number

051333

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2021

Participating Start Date

10/21/2021

Participating Approval Date

10/18/2021

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

105 E Syndor Ave., Suite 204
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	1679038434,1790811289,1447253125

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, Suite 201	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., Suite A	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., Suite 401	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., Suite 501	Ridgecrest	CA	Active
CAH051333-16	Child	CAH	Ridgecrest Regional Hospital	RHC V - SSMC Primary Clinic	105 E Syndor Ave., Suite 100	Ridgecrest	CA	Active
CAH051333-17	Child	CAH	Ridgecrest Regional Hospital	RHC V- Pain Clinic	105 E Syndor Ave., Suite 204	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., Suite 204	Ridgecrest	CA	Active
CAH051333-20	Child	CAH	Ridgecrest Regional Hospital	RHC V- Dermatology Clinic	105 E Syndor Ave., Suite 100	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
Details	Last Recertification Date	Update	Recertification	8/16/2023 12:18:57 AM	8/15/2024 1:03:08 PM	8/15/2024 1:03 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 2:24:55 PM	8/16/2023 12:18:57 AM	8/16/2023 12:18 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 4:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/22/2022 4:35 PM
Addresses	Main Address	Update	Change Request	105 E Syndor St, Suite 201 Ridgecrest, CA 93555	105 E Syndor Ave., Suite 204 Ridgecrest, CA 93555	12/12/2022 1:44 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1790811289	12/12/2022 1:44 PM
Medicaid Billing	NPI: State	Insert	Change Request		CA	12/12/2022 1:44 PM
Details	Entity Subname	Update	Change Request	Pain Management - Pain Management Clinic	RHC V- Pain Clinic	10/4/2022 7:22 AM
Details	Last Recertification Date	Update	Recertification		8/29/2022 2:24:55 PM	8/29/2022 2:24 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	State	Update	OPA Edit	Approved	Active	10/21/2021 9:23 AM
Dates	Start Date	Update	OPA Edit	1/1/2022 12:00:00 AM	10/21/2021 12:00:00 AM	10/21/2021 9:23 AM
Contacts	Signed By	Insert	New Registration		Suver, James CEO Ridgecrest Regional Hospital 7604993902	10/18/2021 7:40 AM
Details	340B ID	Update	New Registration		CAH051333-17	10/18/2021 7:40 AM
Details	Entity Name	Update	New Registration	RIDGECREST REGIONAL HOSPITAL	Ridgecrest Regional Hospital	10/18/2021 7:40 AM
Details	Entity Subname	Update	New Registration	Pain Management	Pain Management - Pain Management Clinic	10/18/2021 7:40 AM
Dates	Participating Approval Date	Update	New Registration		10/18/2021 7:40:37 AM	10/18/2021 7:40 AM
Details	State	Update	New Registration	Pending	Approved	10/18/2021 7:40 AM
Dates	Signed By Date	Update	New Registration		10/15/2021 3:12:47 PM	10/18/2021 7:40 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	10/18/2021 7:40 AM
Addresses	Main Address	Insert	New Registration		105 E Syndor St, Suite 201 Ridgecrest, CA 93555	10/15/2021 12:51 PM
Addresses	Billing Address	Insert	New Registration		Ridgecrest Regional Hospital 1081 N China Lake Blvd Ridgecrest, CA 93555	10/15/2021 12:51 PM
Addresses	Shipping Address	Insert	New Registration		Ridgecrest Regional Hospital 1081 N China Lake Blvd Ridgecrest, CA 93555	10/15/2021 12:51 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/15/2021 12:51 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1447253125	10/15/2021 12:51 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	10/15/2021 12:51 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1679038434	10/15/2021 12:51 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	10/15/2021 12:51 PM
Contacts	Authorizing Official	Insert	New Registration		Suver, James CEO Ridgecrest Regional Hospital 7604993902	10/15/2021 12:51 PM
Contacts	Primary Contact	Insert	New Registration		Rose, Margie Innovation Manager Ridgecrest Regional Hospital 7604993185	10/15/2021 12:51 PM
Details	Assistance Received From Date	Insert	New Registration			10/15/2021 12:51 PM
Details	Assistance Received To Date	Insert	New Registration			10/15/2021 12:51 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2021 12:51 PM
Details	Grant Number	Insert	New Registration			10/15/2021 12:51 PM
Details	340B ID	Insert	New Registration			10/15/2021 12:51 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2021 12:51 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2021 12:51 PM
Details	Medicare Provider Number	Insert	New Registration		051333	10/15/2021 12:51 PM
Details	Entity Name	Insert	New Registration		RIDGECREST REGIONAL HOSPITAL	10/15/2021 12:51 PM
Details	NOFO Number	Insert	New Registration			10/15/2021 12:51 PM
Details	Program Code	Insert	New Registration		CAH	10/15/2021 12:51 PM
Details	Entity Subname	Insert	New Registration		Pain Management	10/15/2021 12:51 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2021 12:51 PM
Details	State	Insert	New Registration		Pending	10/15/2021 12:51 PM
Dates	Registration Date	Insert	New Registration		10/15/2021 12:51:35 PM	10/15/2021 12:51 PM
Dates	Signed By Date	Insert	New Registration			10/15/2021 12:51 PM
Dates	Start Date	Insert	New Registration			10/15/2021 12:51 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2021 12:51 PM
Terminations	Termination Date	Insert	New Registration			10/15/2021 12:51 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2021 12:51 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2021 12:51 PM