Covered Entity Details

DSH050039AE ENLOE MEDICAL CENTER (Active) - information as of 5/16/2025 11:29:35 PM

Main Details

Name

ENLOE MEDICAL CENTER

Subdivision Name

Enloe Advanced Imaging - Imaging

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050039AE

Medicare Provider Number

050039

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/13/2022

Participating Start Date

4/1/2022

Participating Approval Date

2/8/2022

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Enloe Medical Center
Kevin Woodward, VP/Chief Financial Officer
(530) 332-6733

Primary Contact

Enloe Medical Center
Renee Thacker, Director, Finance
(530) 332-7386

Addresses

Street Address

1638 Esplanade
Chico, CA 95926

Billing Address

Enloe Medical Center
1531 Esplanade
Chico, CA 95926

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	HSP40039F	1417901091

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
DSH050039A	Child	DSH	ENLOE MEDICAL CENTER	Enloe Regional Cancer Center / Infusion Therapy Clinic	265 Cohasset Road Suite 160	Chico	CA	Active
DSH050039AA	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Obstetrics & Gynecology - Second Ave	101 W. 2nd Ave	Chico	CA	Active
DSH050039AB	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Obstetrics & Gynecology - South	1405 Magnolia Ave Suite A	Chico	CA	Active
DSH050039AC	Child	DSH	ENLOE MEDICAL CENTER	Enloe Employee Health Center - Enloe Employee Health Center	1405 Magnolia Ave Suite C	Chico	CA	Active
DSH050039AD	Child	DSH	ENLOE MEDICAL CENTER	Cardiology Services Clinic - Esplanade - Cardiology Services	1430 Esplanade	Chico	CA	Active
DSH050039AE	Child	DSH	ENLOE MEDICAL CENTER	Enloe Advanced Imaging - Imaging	1638 Esplanade	Chico	CA	Active
DSH050039AF	Child	DSH	ENLOE MEDICAL CENTER	Urogynecology (708016/718016)	1423 Magnolia Avenue	Chico	CA	Terminated
DSH050039AG	Child	DSH	ENLOE MEDICAL CENTER	Enloe Surgical Oncology - Surgical Oncology	251 Cohasset Road Suite 310	Chico	CA	Active
DSH050039AH	Child	DSH	ENLOE MEDICAL CENTER	Enloe Neurology Clinic - Neurology clinic	340 W. East Ave	Chico	CA	Active
DSH050039AJ	Child	DSH	ENLOE MEDICAL CENTER	Enloe Breast Imaging - Enloe Breast Imaging	251 Cohasset Road	Chico	CA	Active
DSH050039AK	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Cardiology Diagnostic Imaging	178 E 7th Ave	Chico	CA	Active
DSH050039AL	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Bariatric & Metabolic Services - Bariatric	251 Cohasset Road	Chico	CA	Active
DSH050039AM	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Structural Heart & Valve Center	181 E. 7th Ave	Chico	CA	Active
DSH050039AN	Child	DSH	ENLOE MEDICAL CENTER	Enloe Advanced Imaging - Springfield Drive	1555 Springfield Dr.	Chico	CA	Approved
DSH050039B	Child	DSH	ENLOE MEDICAL CENTER	Enloe Outpatient Surgery	888 LAKESIDE VLG COMMONS	CHICO	CA	Active
DSH050039C	Child	DSH	ENLOE MEDICAL CENTER	Enloe Hematology Oncology Clinic	265 COHASSET RD	CHICO	CA	Active
DSH050039D	Child	DSH	ENLOE MEDICAL CENTER	ENLOE WOUND/OSTOMY & HYPERBARIC CENTER	1026 MANGROVE AVE Suite 10	CHICO	CA	Active
DSH050039E	Child	DSH	ENLOE MEDICAL CENTER	ENLOE NEUROSURGICAL & SPINE CLINIC	251 COHASSET RD Suite 370	CHICO	CA	Active
DSH050039F	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Orthopedic & Trauma Surgery	1600 ESPLANADE Suite C	CHICO	CA	Active
DSH050039G	Child	DSH	ENLOE MEDICAL CENTER	Enloe / Behavioral Health	560 COHASSET RD	CHICO	CA	Terminated
DSH050039H	Child	DSH	ENLOE MEDICAL CENTER	Enloe Anticoagulation Clinic	888 LAKESIDE VLG COMMONS Bldg A	CHICO	CA	Active
DSH050039J	Child	DSH	ENLOE MEDICAL CENTER	ENLOE COMPREHENSIVE BREAST CARE	251 Cohasset Road, Suite 220	CHICO	CA	Active
DSH050039K	Child	DSH	ENLOE MEDICAL CENTER	Enloe Prompt Care Cohasset	560 COHASSET ROAD	CHICO	CA	Terminated
DSH050039L	Child	DSH	ENLOE MEDICAL CENTER	Enloe Prompt Care California Park	888 LAKESIDE VLG COMMONS Bldg A	CHICO	CA	Active
DSH050039M	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Ear, Nose & Throat	135 MISSION RANCH BLVD Suite 100	CHICO	CA	Active
DSH050039N	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Obstetrics & Gynecology - Esplanade	1665 ESPLANADE	CHICO	CA	Active
DSH050039P	Child	DSH	ENLOE MEDICAL CENTER	Specialty Clinic Enloe Women's Services	1405 Magnolia Ave	Chico	CA	Terminated
DSH050039Q	Child	DSH	ENLOE MEDICAL CENTER	ENLOE MEDICAL CENTER / Physical Medicine & Rehabilitation Clinic	340 W. EAST AVE	CHICO	CA	Active
DSH050039R	Child	DSH	ENLOE MEDICAL CENTER	ENLOE MEDICAL CENTER / Enloe Endoscopy Clinic	888 LAKESIDE VLG COMMONS Bldg A	CHICO	CA	Active
DSH050039S	Child	DSH	ENLOE MEDICAL CENTER	ENLOE MEDICAL CENTER / Enloe Radiation Oncology Clinic	265 COHASSET RD Suite 140	CHICO	CA	Active
DSH050039T	Child	DSH	ENLOE MEDICAL CENTER	ENLOE MEDICAL CENTER - CARDIOLOGY CLINIC	185 E 7TH AVE Suite C	CHICO	CA	Active
DSH050039U	Child	DSH	ENLOE MEDICAL CENTER	ENLOE GENERAL & COLORECTAL SURGERY - Colorectal	2 GOVERNORS LANE SUITE A	CHICO	CA	Active
DSH050039V	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Joint Replacement	251 COHASSET RD STE 130	CHICO	CA	Active
DSH050039W	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Digestive Health	111 RALEY BLVD #100	CHICO	CA	Active
DSH050039X	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Obstetrics & Gynecology - North	1423 MAGNOLIA AVE	CHICO	CA	Active
DSH050039Y	Child	DSH	ENLOE MEDICAL CENTER	Enloe Health Vascular Surgery Clinic	1600 Esplanade Suite C	Chico	CA	Active
DSH050039Z	Child	DSH	ENLOE MEDICAL CENTER	Enloe Urology clinic - Urology services (708017/718017)	277 Cohasset Rd.	Chico	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/31/2023 7:51:59 PM	9/3/2024 1:18:21 PM	9/3/2024 1:18 PM
Contacts	Primary Contact	Update	PC Change Request	Snelling, Jessica Director of Finance Enloe Medical Center 5303327009	Thacker, Renee Director, Finance Enloe Medical Center 5303327386	8/27/2024 12:09 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 12:21:34 PM	8/31/2023 7:51:59 PM	8/31/2023 7:51 PM
Addresses	Billing Address	Insert	Change Request		Enloe Medical Center 1531 Esplanade Chico, CA 95926	8/7/2023 11:50 AM
Details	Last Recertification Date	Update	Recertification		9/6/2022 12:21:34 PM	9/6/2022 12:21 PM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Woodward, Kevin VP/Chief Financial Officer Enloe Medical Center 5303326733	2/8/2022 2:19 PM
Details	340B ID	Update	New Registration		DSH050039AE	2/8/2022 2:19 PM
Details	Entity Subname	Update	New Registration	Enloe Advanced Imaging	Enloe Advanced Imaging - Imaging	2/8/2022 2:19 PM
Dates	Participating Approval Date	Update	New Registration		2/8/2022 2:19:48 PM	2/8/2022 2:19 PM
Details	State	Update	New Registration	Pending	Approved	2/8/2022 2:19 PM
Dates	Signed By Date	Update	New Registration		1/14/2022 2:29:41 PM	2/8/2022 2:19 PM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	2/8/2022 2:19 PM
Addresses	Main Address	Insert	New Registration		1638 Esplanade Chico, CA 95926	1/13/2022 12:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2022 12:16 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HSP40039F	1/13/2022 12:16 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	1/13/2022 12:16 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1417901091	1/13/2022 12:16 AM
Medicaid Billing	NPI: State	Insert	New Registration		CA	1/13/2022 12:16 AM
Contacts	Authorizing Official	Insert	New Registration		Woodward, Kevin VP/Chief Financial Officer Enloe Medical Center 5303326733	1/13/2022 12:16 AM
Contacts	Primary Contact	Insert	New Registration		Snelling, Jessica Director of Finance Enloe Medical Center 5303327009	1/13/2022 12:16 AM
Details	Assistance Received From Date	Insert	New Registration			1/13/2022 12:16 AM
Details	Assistance Received To Date	Insert	New Registration			1/13/2022 12:16 AM
Details	Last Recertification Date	Insert	New Registration			1/13/2022 12:16 AM
Details	Grant Number	Insert	New Registration			1/13/2022 12:16 AM
Details	340B ID	Insert	New Registration			1/13/2022 12:16 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2022 12:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2022 12:16 AM
Details	Medicare Provider Number	Insert	New Registration		050039	1/13/2022 12:16 AM
Details	Entity Name	Insert	New Registration		ENLOE MEDICAL CENTER	1/13/2022 12:16 AM
Details	NOFO Number	Insert	New Registration			1/13/2022 12:16 AM
Details	Program Code	Insert	New Registration		DSH	1/13/2022 12:16 AM
Details	Entity Subname	Insert	New Registration		Enloe Advanced Imaging	1/13/2022 12:16 AM
Dates	Participating Approval Date	Insert	New Registration			1/13/2022 12:16 AM
Details	State	Insert	New Registration		Pending	1/13/2022 12:16 AM
Dates	Registration Date	Insert	New Registration		1/13/2022 12:16:03 AM	1/13/2022 12:16 AM
Dates	Signed By Date	Insert	New Registration			1/13/2022 12:16 AM
Dates	Start Date	Insert	New Registration			1/13/2022 12:16 AM
Terminations	Termination Comments	Insert	New Registration			1/13/2022 12:16 AM
Terminations	Termination Date	Insert	New Registration			1/13/2022 12:16 AM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2022 12:16 AM
Terminations	Termination Reason	Insert	New Registration			1/13/2022 12:16 AM