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DSH050082H ST JOHNS REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
ST JOHNS REGIONAL MEDICAL CENTER
Subdivision Name
St. John's Hospital Camarillo - CARDIAC CATHETERIZATION SVCS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050082H
Medicare Provider Number
050082
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/28/2021
Participating Start Date
5/14/2021
Participating Approval Date
5/14/2021
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
St. John's Regional Medical Center
Emma Grossman, VP, CFO
(805) 988-2754
Primary Contact
CommonSpirit Health
Ryan Pearcy, 340B Region Manager
(859) 229-5654
Addresses
Street Address
2309 Antonio Ave
Camarillo, CA 93010
Billing Address
Dignity Health AP
3033 North 3rd Avenue
Phoenix, AZ 85013
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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