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DSH050099A SAN ANTONIO REGIONAL HOSPITAL (Active)
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Main Details
Name
SAN ANTONIO REGIONAL HOSPITAL
Subdivision Name
Rancho Cucamonga / Urgent Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050099A
Medicare Provider Number
050099
Outpatient Facility Provider Number
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
8/20/2024
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
7777-A Milliken Avenue
Suite B
Rancho Cucamonga, CA 91730-7489
Billing Address
San Antonio Regional Hospital
999 San Bernadino Road
Upland, CA 91786
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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