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DSH050099D SAN ANTONIO REGIONAL HOSPITAL (Active)
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Main Details
Name
SAN ANTONIO REGIONAL HOSPITAL
Subdivision Name
Sierra / Urgent Care - Urgent Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050099D
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
11/15/2017
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
16465 Sierra Lakes Pkwy
Fontana, CA 92336
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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