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DSH050315A KERN MEDICAL CENTER (Terminated)
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Main Details
Name
KERN MEDICAL CENTER
Subdivision Name
SAGEBRUSH MEDICAL CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050315A
Medicare Provider Number
050315
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/29/2008
Participating Start Date
10/1/1995
Participating Approval Date
4/29/2008
Last Recertification Date
8/13/2024
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Kern Medical Center
Scott Thygerson, Chief Executive Officer
(661) 326-2102
Primary Contact
Kern Medical
Jeffrey Charles Jolliff, Director of Pharmacy
(661) 326-2191
Addresses
Street Address
1111 COLUMBUS STREET
BAKERSFIELD, CA 93305
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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02/14/2012 updated sub-name (was SAGEBRUSH PHARMACY); 3/18/04 CARVE OUT/DELETE MED #PHOE30370
02/14/2012
3/18/04 CARVE OUT/DELETE MED #PHOE30370
04/29/2008
April 2025
April 2025
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