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DSH050129B ST. BERNARDINE MEDICAL CENTER (Active)
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Main Details
Name
ST. BERNARDINE MEDICAL CENTER
Subdivision Name
Urgent Care Fontana
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050129B
Medicare Provider Number
050129
Outpatient Facility Provider Number
050129
Additional Details
Current Program Status
Active
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
St. Bernardine Medical Center
Charlie Abraham, AO
(909) 883-8711
Primary Contact
St. Bernardine Medical Center
Jason M Vest, Director of Pharmacy
(909) 881-4473
Addresses
Street Address
17051 Sierra Lakes Parkway Suite #102
Fontana, CA 92336
Billing Address
Dignity Health Accounts Payable
3033 N. 3rd Avenue
Phoenix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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