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DSH050099 SAN ANTONIO REGIONAL HOSPITAL (Active)
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Main Details
Name
SAN ANTONIO REGIONAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050099
Medicare Provider Number
050099
Additional Details
Current Program Status
Active
Registration Date
10/12/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/30/2017
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
San Antonio Regional Hospital
Peter Aprato, Compliance Officer
(909) 694-1098
Primary Contact
San Antonio Regional Hospital
Dennis Ancheta, Director of Pharmacy
(909) 920-4849 Ext: 24849
Addresses
Street Address
999 SAN BERNARDINO ROAD
UPLAND, CA 91786
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating 1/1/2017 until terminated effective 10/1/2017; reinstated effective 1/1/2018.
10/19/2017
April 2025
April 2025
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