Covered Entity Details

DSH050396K SANTA BARBARA COTTAGE HOSPITAL (Active) - information as of 4/25/2025 6:36:35 PM

Main Details

Name

SANTA BARBARA COTTAGE HOSPITAL

Subdivision Name

Cottage Center for Advanced Imaging - Imaging

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH050396K

Medicare Provider Number

050396

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/2/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/2/2024

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Santa Barbara Cottage Hospital
Kristin Tufvesson, Sr. Vice President Finance & CFO
(805) 879-8941

Primary Contact

Santa Barbara Cottage Hospital
Joseph Jolliff, Director of Pharmacy Services
(805) 569-7396

Addresses

Street Address

2410 Fletcher Ave.
Santa Barbara, CA 93105

Billing Address

Santa Barbara Cottage Hospital
PO Box 8180
Goleta, CA 93118

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	ZZT30396F,ZZT40396F	1477554152,1609234483

Shipping Addresses

Shipping Address 1

Santa Barbara Cottage Hospital
400 West Pueblo Street
Santa Barbara, CA 93105

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
DSH050396A	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Grotenhuis Pediatric Specialty Clinics	5333 Hollister Ave	Goleta	CA	Active
DSH050396B	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	OPS - Outpatient Surgery	2403 Castillo Street	Santa Barbara	CA	Active
DSH050396C	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cystic Fibrosis & Bronchiectasis Clinic - CF Clinic	2409 De La Vina Street	Santa Barbara	CA	Active
DSH050396D	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Macdougall Eye Center - Eye Center	2403 Castillo Street	Santa Barbara	CA	Active
DSH050396E	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	TX Center - Transfusion Center	2400 Bath Street	Santa Barbara	CA	Terminated
DSH050396F	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Pulmonary Hypertension Clinic - PHC	2409 De La Vina Street	Santa Barbara	CA	Terminated
DSH050396G	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	COPE Intensive Outpatient Programs of San Luis Obispo - Mental Health	628 California Blvd.	San Luis Obispo	CA	Active
DSH050396H	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cottage Surgical Clinics - Surgery	2400 Bath St.	Santa Barbara	CA	Active
DSH050396J	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	COPE Intensive Outpatient Programs of Santa Barbara - Mental Health	2403 Castillo Street	Santa Barbara	CA	Active
DSH050396K	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cottage Center for Advanced Imaging - Imaging	2410 Fletcher Ave.	Santa Barbara	CA	Active
DSH050396L	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cottage Cardiology Clinic Santa Barbara - Cardiovascular Clinic	221 West Pueblo Street	Santa Barbara	CA	Active
DSH050396M	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cottage Primary Care – Santa Barbara – Oak Park - Primary Care	2329 Oak Park Lane	Santa Barbara	CA	Terminated
DSH050396N	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cottage Obstetrics & Gynecology Clinic - Obstetrics & Gynecology	2416 Castillo St.	Santa Barbara	CA	Terminated
DSH050396P	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cottage Primary Care – Santa Ynez Valley – Old Mission - Primary Care	1992 Old Mission Dr.	Solvang	CA	Terminated
DSH050396Q	Child	DSH	SANTA BARBARA COTTAGE HOSPITAL	Cottage Residential Center - Psychiatry	316 W. Montecito St.	Santa Barbara	CA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/29/2024 6:09:01 PM	8/29/2024 6:09 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Tufvesson, Kristin Sr. Vice President Finance & CFO Santa Barbara Cottage Hospital 8058798941	1/2/2024 12:47 PM
Details	340B ID	Update	New Registration		DSH050396K	1/2/2024 12:47 PM
Details	Entity Subname	Update	New Registration	Cottage Center for Advanced Imaging	Cottage Center for Advanced Imaging - Imaging	1/2/2024 12:47 PM
Dates	Participating Approval Date	Update	New Registration		1/2/2024 12:47:37 PM	1/2/2024 12:47 PM
Details	State	Update	New Registration	Pending	Approved	1/2/2024 12:47 PM
Dates	Signed By Date	Update	New Registration		1/2/2024 12:14:09 PM	1/2/2024 12:47 PM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/2/2024 12:47 PM
Addresses	Main Address	Insert	New Registration		2410 Fletcher Ave. Santa Barbara, CA 93105	1/2/2024 11:38 AM
Addresses	Billing Address	Insert	New Registration		Santa Barbara Cottage Hospital PO Box 8180 Goleta, CA 93118	1/2/2024 11:38 AM
Addresses	Shipping Address	Insert	New Registration		Santa Barbara Cottage Hospital 400 West Pueblo Street Santa Barbara, CA 93105	1/2/2024 11:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/2/2024 11:38 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		ZZT30396F	1/2/2024 11:38 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	1/2/2024 11:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/2/2024 11:38 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		ZZT40396F	1/2/2024 11:38 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	1/2/2024 11:38 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1477554152	1/2/2024 11:38 AM
Medicaid Billing	NPI: State	Insert	New Registration		CA	1/2/2024 11:38 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1609234483	1/2/2024 11:38 AM
Medicaid Billing	NPI: State	Insert	New Registration		CA	1/2/2024 11:38 AM
Contacts	Primary Contact	Insert	New Registration		Jolliff, Joseph Director of Pharmacy Services Santa Barbara Cottage Hospital 8055697396	1/2/2024 11:38 AM
Contacts	Authorizing Official	Insert	New Registration		Tufvesson, Kristin Sr. Vice President Finance & CFO Santa Barbara Cottage Hospital 8058798941	1/2/2024 11:38 AM
Details	Assistance Received From Date	Insert	New Registration			1/2/2024 11:38 AM
Details	Assistance Received To Date	Insert	New Registration			1/2/2024 11:38 AM
Details	Last Recertification Date	Insert	New Registration			1/2/2024 11:38 AM
Details	Grant Number	Insert	New Registration			1/2/2024 11:38 AM
Details	340B ID	Insert	New Registration			1/2/2024 11:38 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/2/2024 11:38 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/2/2024 11:38 AM
Details	Medicare Provider Number	Insert	New Registration		050396	1/2/2024 11:38 AM
Details	Entity Name	Insert	New Registration		SANTA BARBARA COTTAGE HOSPITAL	1/2/2024 11:38 AM
Details	NOFO Number	Insert	New Registration			1/2/2024 11:38 AM
Details	Program Code	Insert	New Registration		DSH	1/2/2024 11:38 AM
Details	Entity Subname	Insert	New Registration		Cottage Center for Advanced Imaging	1/2/2024 11:38 AM
Dates	Participating Approval Date	Insert	New Registration			1/2/2024 11:38 AM
Details	State	Insert	New Registration		Pending	1/2/2024 11:38 AM
Dates	Registration Date	Insert	New Registration		1/2/2024 11:38:49 AM	1/2/2024 11:38 AM
Dates	Signed By Date	Insert	New Registration			1/2/2024 11:38 AM
Dates	Start Date	Insert	New Registration			1/2/2024 11:38 AM
Terminations	Termination Comments	Insert	New Registration			1/2/2024 11:38 AM
Terminations	Termination Date	Insert	New Registration			1/2/2024 11:38 AM
Terminations	Termination Effective Date	Insert	New Registration			1/2/2024 11:38 AM
Terminations	Termination Reason	Insert	New Registration			1/2/2024 11:38 AM