Covered Entity Details

DSH050026U GROSSMONT HOSPITAL (Active) - information as of 4/25/2025 9:20:04 PM

Main Details

Name

GROSSMONT HOSPITAL

Subdivision Name

SGH O/P Specialty Clinic - Stroke Follow up

Type

Disproportionate Share Hospital

Rural

340B ID

DSH050026U

Medicare Provider Number

050026

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2023

Participating Start Date

4/1/2023

Participating Approval Date

1/23/2023

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Grossmont Hospital
Daniel Kindron, CFO
(619) 740-4743

Primary Contact

Sharp HealthCare
Zephyr T Skeets, 340B Specialist
(858) 499-2148

Addresses

Street Address

8851 Center Dr.
Suite 600
La Mesa, CA 91942

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	HSC30026G	1528041811

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
DSH050026B	Child	DSH	GROSSMONT HOSPITAL	SHARP HOME INFUSION SERVICES	3558 RUFFIN ROAD SOUTH	SAN DIEGO	CA	Active
DSH050026C	Child	DSH	GROSSMONT HOSPITAL	Grossmont Medical Terrace - O/P IMAGING	8860 Center Drive	La Mesa	CA	Active
DSH050026D	Child	DSH	GROSSMONT HOSPITAL	Grossmont Medical Terrace - O/P Infusion Clinic	8860 Center Drive	La Mesa	CA	Active
DSH050026E	Child	DSH	GROSSMONT HOSPITAL	Sharp Home Infusion - Specialty Services	3558 RUFFIN ROAD SOUTH	San Diego	CA	Terminated
DSH050026F	Child	DSH	GROSSMONT HOSPITAL	O/P Surgery Center	5525 Grossmont Center Drive	La Mesa	CA	Active
DSH050026G	Child	DSH	GROSSMONT HOSPITAL	Brier Patch Outpatient Rehabilitation Services - Diabetes Clinic	9000 Wakarusa Street	La Mesa	CA	Active
DSH050026H	Child	DSH	GROSSMONT HOSPITAL	Brier Patch Outpatient Rehabilitation Services - Occupational Clinic	9000 Wakarusa Street	La Mesa	CA	Active
DSH050026J	Child	DSH	GROSSMONT HOSPITAL	Brier Patch Outpatient Rehabilitation Services - Physical Therapy Clinic	9000 Wakarusa Street	La Mesa	CA	Active
DSH050026K	Child	DSH	GROSSMONT HOSPITAL	Hospice Administration	4000 Ruffin Road	San Diego	CA	Active
DSH050026L	Child	DSH	GROSSMONT HOSPITAL	LakeView Hospice Residence	9472 Loren Dr	La Mesa	CA	Active
DSH050026M	Child	DSH	GROSSMONT HOSPITAL	ParkView Hospice	5788 Lyden Way	San Diego	CA	Active
DSH050026N	Child	DSH	GROSSMONT HOSPITAL	BonitaView Hospice	3850 Valley Vista Rd	Bonita	CA	Active
DSH050026P	Child	DSH	GROSSMONT HOSPITAL	Care Clinic - Care Clinic	8851 Center Dr.	La Mesa	CA	Active
DSH050026Q	Child	DSH	GROSSMONT HOSPITAL	Prenatal Ultrasound - Ultrasound	8851 Center Dr.	La Mesa	CA	Active
DSH050026R	Child	DSH	GROSSMONT HOSPITAL	Maternal Fetal - Maternal Fetal Care	8851 Center Dr.	La Mesa	CA	Active
DSH050026S	Child	DSH	GROSSMONT HOSPITAL	Perinatal Clinic - Perinatal care	8851 Center Dr.	La Mesa	CA	Active
DSH050026T	Child	DSH	GROSSMONT HOSPITAL	Burr Clinic	5525 Grossmont Center Dr.	La Mesa	CA	Active
DSH050026U	Child	DSH	GROSSMONT HOSPITAL	SGH O/P Specialty Clinic - Stroke Follow up	8851 Center Dr.	La Mesa	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 3:20:54 PM	9/3/2024 4:38:06 PM	9/3/2024 4:38 PM
Contacts	Primary Contact	Update	Recertification	Sachs, Susan System Pharmacy Manager Sharp HealthCare 8584994220	Skeets, Zephyr T 340B Specialist Sharp HealthCare 8584992148	9/5/2023 3:20 PM
Details	Last Recertification Date	Update	Recertification		9/5/2023 3:20:54 PM	9/5/2023 3:20 PM
Details	State	Update		Approved	Active	4/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Kindron, Daniel CFO Grossmont Hospital 6197404743	1/23/2023 6:32 AM
Details	340B ID	Update	New Registration		DSH050026U	1/23/2023 6:32 AM
Details	Entity Subname	Update	New Registration	SGH O/P Specialty Clinic	SGH O/P Specialty Clinic - Stroke Follow up	1/23/2023 6:32 AM
Dates	Participating Approval Date	Update	New Registration		1/23/2023 6:32:46 AM	1/23/2023 6:32 AM
Details	State	Update	New Registration	Pending	Approved	1/23/2023 6:32 AM
Dates	Signed By Date	Update	New Registration		1/11/2023 2:13:04 PM	1/23/2023 6:32 AM
Dates	Start Date	Update	New Registration		4/1/2023 12:00:00 AM	1/23/2023 6:32 AM
Addresses	Main Address	Insert	New Registration		8851 Center Dr. Suite 600 La Mesa, CA 91942	1/9/2023 2:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2023 2:56 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HSC30026G	1/9/2023 2:56 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	1/9/2023 2:56 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528041811	1/9/2023 2:56 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	1/9/2023 2:56 PM
Contacts	Primary Contact	Insert	New Registration		Sachs, Susan System Pharmacy Manager Sharp HealthCare 8584994220	1/9/2023 2:56 PM
Contacts	Authorizing Official	Insert	New Registration		Kindron, Daniel CFO Grossmont Hospital 6197404743	1/9/2023 2:56 PM
Details	Assistance Received From Date	Insert	New Registration			1/9/2023 2:56 PM
Details	Assistance Received To Date	Insert	New Registration			1/9/2023 2:56 PM
Details	Last Recertification Date	Insert	New Registration			1/9/2023 2:56 PM
Details	Grant Number	Insert	New Registration			1/9/2023 2:56 PM
Details	340B ID	Insert	New Registration			1/9/2023 2:56 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2023 2:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2023 2:56 PM
Details	Medicare Provider Number	Insert	New Registration		050026	1/9/2023 2:56 PM
Details	Entity Name	Insert	New Registration		GROSSMONT HOSPITAL	1/9/2023 2:56 PM
Details	NOFO Number	Insert	New Registration			1/9/2023 2:56 PM
Details	Program Code	Insert	New Registration		DSH	1/9/2023 2:56 PM
Details	Entity Subname	Insert	New Registration		SGH O/P Specialty Clinic	1/9/2023 2:56 PM
Dates	Participating Approval Date	Insert	New Registration			1/9/2023 2:56 PM
Details	State	Insert	New Registration		Pending	1/9/2023 2:56 PM
Dates	Registration Date	Insert	New Registration		1/9/2023 2:56:18 PM	1/9/2023 2:56 PM
Dates	Signed By Date	Insert	New Registration			1/9/2023 2:56 PM
Dates	Start Date	Insert	New Registration			1/9/2023 2:56 PM
Terminations	Termination Comments	Insert	New Registration			1/9/2023 2:56 PM
Terminations	Termination Date	Insert	New Registration			1/9/2023 2:56 PM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2023 2:56 PM
Terminations	Termination Reason	Insert	New Registration			1/9/2023 2:56 PM