340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH050300B ST. MARY MEDICAL CENTER (Active)
Print
Main Details
Name
ST. MARY MEDICAL CENTER
Subdivision Name
ST. MARY MEDICAL CENTER WOUND CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050300B
Medicare Provider Number
050300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/1/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
St Mary Medical Center
Eugene Gutierrez, Chief Financial Officer
(760) 946-8105
Primary Contact
St Mary Medical Center
Winna Asuming, Director of Pharmacy
(760) 946-4238
Addresses
Street Address
16077 KAMANA ROAD
APPLE VALLEY, CA 92307
Billing Address
ST MARY MEDICAL CENTER
PO BOX 696431
SAN ANTONIO, TX 78269
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session