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DSH050129F ST. BERNARDINE MEDICAL CENTER (Active)
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Main Details
Name
ST. BERNARDINE MEDICAL CENTER
Subdivision Name
Wound Healing Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050129F
Medicare Provider Number
050129
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/4/2016
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
27925 Highland Ave
Highland, CA 92346
Billing Address
Dignity Health Accounts Payable
3033 N. 3rd Avenue
Phoenix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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