Cement Masons Health and Welfare Trust Fund for Northern California 220 Campus Lane Fairfield, CA 94534-1499 1 707 864 3300 or 1 888 245 5005 www.norcalcementmasons.org General Announcement June 20, 2014 Dear Participants and Eligible Dependents: Preliminary Notice of PPO Network Cancellation Important Read Carefully Your Action Is Required. The Trust Fund Office has been notified by Anthem Blue Cross of a possible termination of the Dignity Health network, effective July 16, 2014. Anthem Blue Cross and Dignity Health continue in negotiations and will attempt to work towards mutually agreeable contracts. However, in the meantime, we must assume that there is a very good likelihood that the Dignity Health network will terminate on July 16, 2014. Plan Participants and their eligible Dependents should be on notice that as of July 16, 2014, certain Hospitals and other Providers of Service (Physicians, laboratories, etc.) within the Dignity Health network will not be available to you as a PPO. If the PPO contract is not renewed and you continue to use a Hospital or Provider of Service that is no longer a PPO, your claims will be reimbursed at the Non-PPO rate. This means you may have a higher than usual share of cost on your claims. You can find a list of the affected Hospitals, along with a list of alternative Hospitals in the Southern and Northern Regions of California, located at the Trust Funds website www.norcalcementmasons.org. If you do not have access to the internet where you can visit the Trust Funds website, call the Trust Fund Office at 1 888 245 5005. Physicians, laboratories, and other providers under the Dignity Health are also affected. Unfortunately, we do not have a list of all affected non-hospital providers. You must, therefore, be cautious when you use a Provider of Service on or after July 16, 2014. Always confirm that your Hospital or non-hospital provider is part of the Anthem Blue Cross Advantage PPO network before you schedule an appointment. Sincerely, Board of Trustees Keep this General Announcement with your September 2007 Health and Welfare Plan booklet
Dignity Health - Alternate Hospital List May 2014 Dignity Health - Southern Regional Hospitals ARROYO GRANDE COMMUNITY HOSPITAL 345 S HALCYON RD ARROYO CA 93420 SAN LUIS OBISPO SIERRA VISTA REGIONAL MEDICAL CENTER 1010 MURRAY AVE SAN LUIS OBISPO CA 93401 SAN LUIS OBISPO TWIN CITIES COMMUNITY HOSPITAL INC 1100 LAS TABLAS RD TEMPLETON CA 93465 SAN LUIS OBISPO BAKERSFIELD MEMORIAL HOSPITAL 420 34TH ST BAKERSFIELD CA 93301 KERN GOOD SAMARITAN HOSPITAL 901 OLIVE DR BAKERSFIELD CA 93308 KERN KERN MEDICAL CENTER 1700 MOUNT VERNON AVE BAKERSFIELD CA 93306 KERN SAN JOAQUIN COMMUNITY HOSPITAL 2615 CHESTER AVE BAKERSFIELD CA 93301 KERN CALIFORNIA HOSPITAL MEDICAL CENTER 1401 S GRAND AVE CA 90015 AHMC GARFIELD HOSPITAL MEDICAL 525 N GARFIELD AVE MONTEREY PARK CA 91754 ALHAMBRA HOSPITAL MEDICAL CENTER 100 S RAYMOND AVE ALHAMBRA CA 91801 BEVERLY HOSPITAL 309 W BEVERLY BLVD MONTEBELLO CA 90640 CEDARS SINAI MEDICAL CENTER 8700 BEVERLY BLVD CA 90048 CENTINELA HOSPITAL MEDICAL CENTER 555 E HARDY ST INGLEWOOD CA 90301 CHILDRENS HOSPITAL 4650 W SUNSET BLVD CA 90027 CITRUS VALLEY MED CTRS-QUEEN OF THE VALLEY CAMPUS 1115 S SUNSET AVE WEST COVINA CA 91790 CITY OF HOPE NATIONAL MEDICAL CENTER 1500 DUARTE RD DUARTE CA 91010 COMMUNITY HOSPITAL LONG BEACH 1720 TERMINO AVE LONG BEACH CA 90804 DOCTORS HOSPITAL OF WEST COVINA 725 S ORANGE AVE WEST COVINA CA 91790 DOWNEY REGIONAL MEDICAL CENTER - HOSPITAL INC 11500 BROOKSHIRE AVE DOWNEY CA 90241 ENCINO HOSPITAL MEDICAL CENTER 16237 VENTURA BLVD ENCINO CA 91436 GLENDALE ADVENTIST MEDICAL CENTER 1509 WILSON TER GLENDALE CA 91206 GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BLVD CA 90017 GREATER EL MONTE COMMUNITY HOSPITAL 1701 SANTA ANITA AVE SOUTH EL CA 91733 HOLLYWOOD COMMUNITY HOSPITAL AT BROTMAN 3828 DELMAS TER CULVER CITY CA 90232 HOLLYWOOD PRESBYTERIAN MEDICAL CENTER 1300 N VERMONT AVE CA 90027 HUNTINGTON MEMORIAL HOSPITAL 100 W CALIFORNIA BLVD PASADENA CA 91105 KENNETH NORRIS JR CANCER HOSPITAL 1441 EASTLAKE AVE CA 90033 LA PALMA INTERCOMMUNITY HOSPITAL LLC 7901 WALKER ST LA PALMA CA 90623 ORANGE LAKEWOOD REGIONAL MEDICAL CENTER 3700 SOUTH ST LAKEWOOD CA 90712 LONG BEACH MEMORIAL MEDICAL CENTER 2801 ATLANTIC AVE LONG BEACH CA 90806 LOS ALAMITOS MEDICAL CENTER 3751 KATELLA AVE LOS ALAMITOS CA 90720 ORANGE ORTHOPEDIC MEDICAL CENTER 2400 S FLOWER ST CA 90007 Page 1
MARINA DEL REY HOSPITAL 4650 LINCOLN BLVD MARINA DEL REY CA 90292 METHODIST HOSPITAL OF SOUTHERN CALIFORNIA 300 W HUNTINGTON DR ARCADIA CA 91007 MILLER CHILDRENS HOSPITAL 2801 ATLANTIC AVE LONG BEACH CA 90806 MIRACLE MILE MEDICAL CENTER 6000 SAN VICENTE BLVD CA 90036 MISSION COMMUNITY HOSPITAL-PANORAMA CAMPUS 14850 ROSCOE BLVD PANORAMA CITY CA 91402 MONTEREY PARK HOSPITAL 900 S ATLANTIC BLVD MONTEREY PARK CA 91754 OLYMPIA MEDICAL CENTER 5900 W OLYMPIC BLVD CA 90036 PACIFIC ALLIANCE MEDICAL CENTER 531 W COLLEGE ST CA 90012 PACIFIC HOSPITAL OF LONG BEACH 2776 PACIFIC AVE LONG BEACH CA 90806 PACIFICA HOSPITAL OF THE VALLEY 9449 SAN FERNANDO RD SUN VALLEY CA 91352 PRESBYTERIAN INTERCOMMUNITY HOSPITAL 12401 WASHINGTON BLVD WHITTIER CA 90602 PROMISE HOSP OF EAST -SUBURBAN CAMPUS 16453 COLORADO AVE PARAMOUNT CA 90723 PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE 4101 TORRANCE BLVD TORRANCE CA 90503 PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO 1300 W 7TH ST SAN PEDRO CA 90732 PROVIDENCE SAINT JOSEPH MEDICAL CENTER 501 S BUENA VISTA ST BURBANK CA 91505 PROVIDENCE TARZANA MEDICAL CENTER 18321 CLARK ST TARZANA CA 91356 RONALD REAGAN UCLA MEDICAL CENTER 757 WESTWOOD PLZ CA 90095 SAN GABRIEL VALLEY MEDICAL CENTER 438 W LAS TUNAS DR SAN GABRIEL CA 91776 SANTA MONICA UCLA MEDICAL CENTER 1250 16TH ST SANTA MONICA CA 90404 SHERMAN OAKS HOSPITAL 4929 VAN NUYS BLVD SHERMAN OAKS CA 91403 ST FRANCIS MEDICAL CENTER 3630 E IMPERIAL HWY LYNWOOD CA 90262 ST JOHNS HOSPITAL AND HEALTH CENTER 1328 22ND ST SANTA MONICA CA 90404 ST VINCENT MEDICAL CENTER 2131 W 3RD ST CA 90057 TEMPLE COMMUNITY HOSPITAL 235 N HOOVER ST CA 90004 TORRANCE MEMORIAL MEDICAL CENTER 3330 LOMITA BLVD TORRANCE CA 90505 TRI CITY REGIONAL MEDICAL CENTER 21530 PIONEER BLVD HAWAIIAN CA 90716 USC UNIVERSITY HOSPITAL 1500 SAN PABLO ST CA 90033 VALLEY PRESBYTERIAN HOSPITAL 15107 VANOWEN ST VAN NUYS CA 91409 VERDUGO HILLS HOSPITAL 1812 VERDUGO BLVD GLENDALE CA 91208 WEST ANAHEIM MEDICAL CENTER 3033 W ORANGE AVE ANAHEIM CA 92804 ORANGE WHITE MEMORIAL MEDICAL CENTER 1720 E CESAR E CHAVEZ CA 90033 WHITTIER HOSPITAL MEDICAL CENTER 9080 COLIMA RD WHITTIER CA 90605 COMMUNITY HOSPITAL OF SAN BERNARDINO 1805 MEDICAL CENTER DR SN BERNRDNO CA 92411 SAN BERNARDINO LOMA LINDA UNIVERSITY MEDICAL CENTER 11234 ANDERSON ST LOMA LINDA CA 92354 SAN BERNARDINO PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER 3865 JACKSON ST RIVERSIDE CA 92503 RIVERSIDE REDLANDS COMMUNITY HOSPITAL 350 TERRACINA BLVD REDLANDS CA 92373 SAN BERNARDINO RIVERSIDE COMMUNITY HOSPITAL 4445 MAGNOLIA AVE RIVERSIDE CA 92501 RIVERSIDE SAN ANTONIO COMMUNITY HOSPITAL 999 SAN BERNARDINO RD UPLAND CA 91786 SAN BERNARDINO FRENCH HOSPITAL MEDICAL CENTER 1911 JOHNSON AVE SAN LUIS CA 93401 SAN LUIS OBISPO SIERRA VISTA REGIONAL MEDICAL CENTER 1010 MURRAY AVE SAN LUIS OBISPO CA 93401 SAN LUIS OBISPO Page 2
TWIN CITIES COMMUNITY HOSPITAL INC 1100 LAS TABLAS RD TEMPLETON CA 93465 SAN LUIS OBISPO Terminating Hospital street addr city state zip code GLENDALE MEMORIAL HOSPITAL & HEALTH CENTER 1420 S CENTRAL AVE GLENDALE CA 91204 AHMC GARFIELD HOSPITAL MEDICAL 525 N GARFIELD AVE MONTEREY PARK CA 91754 ALHAMBRA HOSPITAL MEDICAL CENTER 100 S RAYMOND AVE ALHAMBRA CA 91801 BEVERLY HOSPITAL 309 W BEVERLY BLVD MONTEBELLO CA 90640 CEDARS SINAI MEDICAL CENTER 8700 BEVERLY BLVD CA 90048 CENTINELA HOSPITAL MEDICAL CENTER 555 E HARDY ST INGLEWOOD CA 90301 CHILDRENS HOSPITAL 4650 W SUNSET BLVD CA 90027 CITY OF HOPE NATIONAL MEDICAL CENTER 1500 DUARTE RD DUARTE CA 91010 DOCTORS HOSPITAL OF WEST COVINA 725 S ORANGE AVE WEST COVINA CA 91790 DOWNEY REGIONAL MEDICAL CENTER - HOSPITAL INC 11500 BROOKSHIRE AVE DOWNEY CA 90241 ENCINO HOSPITAL MEDICAL CENTER 16237 VENTURA BLVD ENCINO CA 91436 GLENDALE ADVENTIST MEDICAL CENTER 1509 WILSON TER GLENDALE CA 91206 GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BLVD CA 90017 GREATER EL MONTE COMMUNITY HOSPITAL 1701 SANTA ANITA AVE SOUTH EL CA 91733 HOLLYWOOD COMMUNITY HOSPITAL AT BROTMAN 3828 DELMAS TER CULVER CITY CA 90232 HOLLYWOOD PRESBYTERIAN MEDICAL CENTER 1300 N VERMONT AVE CA 90027 HUNTINGTON MEMORIAL HOSPITAL 100 W CALIFORNIA BLVD PASADENA CA 91105 KENNETH NORRIS JR CANCER HOSPITAL 1441 EASTLAKE AVE CA 90033 ORTHOPAEDIC MEDICAL CENTER 2400 S FLOWER ST CA 90007 MARINA DEL REY HOSPITAL 4650 LINCOLN BLVD MARINA DEL REY CA 90292 METHODIST HOSPITAL OF SOUTHERN CALIFORNIA 300 W HUNTINGTON DR ARCADIA CA 91007 MIRACLE MILE MEDICAL CENTER 6000 SAN VICENTE BLVD CA 90036 MISSION COMMUNITY HOSPITAL-PANORAMA CAMPUS 14850 ROSCOE BLVD PANORAMA CITY CA 91402 MONTEREY PARK HOSPITAL 900 S ATLANTIC BLVD MONTEREY PARK CA 91754 OLYMPIA MEDICAL CENTER 5900 W OLYMPIC BLVD CA 90036 PACIFIC ALLIANCE MEDICAL CENTER 531 W COLLEGE ST CA 90012 PACIFICA HOSPITAL OF THE VALLEY 9449 SAN FERNANDO RD SUN VALLEY CA 91352 PROVIDENCE HOLY CROSS MEDICAL CENTER 15031 RINALDI ST MISSION HILLS CA 91345 PROVIDENCE SAINT JOSEPH MEDICAL CENTER 501 S BUENA VISTA ST BURBANK CA 91505 PROVIDENCE TARZANA MEDICAL CENTER 18321 CLARK ST TARZANA CA 91356 RONALD REAGAN UCLA MEDICAL CENTER 757 WESTWOOD PLZ CA 90095 SAN GABRIEL VALLEY MEDICAL CENTER 438 W LAS TUNAS DR SAN GABRIEL CA 91776 SANTA MONICA UCLA MEDICAL CENTER 1250 16TH ST SANTA MONICA CA 90404 SHERMAN OAKS HOSPITAL 4929 VAN NUYS BLVD SHERMAN OAKS CA 91403 ST FRANCIS MEDICAL CENTER 3630 E IMPERIAL HWY LYNWOOD CA 90262 ST JOHNS HOSPITAL AND HEALTH CENTER 1328 22ND ST SANTA MONICA CA 90404 ST VINCENT MEDICAL CENTER 2131 W 3RD ST CA 90057 TEMPLE COMMUNITY HOSPITAL 235 N HOOVER ST CA 90004 USC UNIVERSITY HOSPITAL 1500 SAN PABLO ST CA 90033 VALLEY PRESBYTERIAN HOSPITAL 15107 VANOWEN ST VAN NUYS CA 91409 VERDUGO HILLS HOSPITAL 1812 VERDUGO BLVD GLENDALE CA 91208 WHITE MEMORIAL MEDICAL CENTER 1720 E CESAR E CHAVEZ AVE CA 90033 Page 3
Terminating Hospital MARIAN MEDICAL CENTER Alternate Hospitals GOLETA VALLEY COTTAGE HOSPITAL LOMPOC HEALTHCARE DISTRICT SANTA BARBARA COTTAGE HOSPITAL SANTA YNEZ VALLEY COTTAGE HOSPITAL SIERRA VISTA REGIONAL MEDICAL CENTER street addr city state zip code 1400 E CHURCH ST SANTA MARIA CA 93454 SANTA BARBARA street addr city state zip code 351 S PATTERSON AV SANTA BARBARA CA 93105 SANTA BARBARA 508 E HICKORY AVE LOMPOC CA 93436 SANTA BARBARA PUEBLO AT BATH SANTA BARBARA CA 93105 SANTA BARBARA 2050 VIBORG RD SOVANG CA 93463 SANTA BARBARA 1010 MURRAY AVE SAN LUIS OBISPO CA 93401 SAN LUIS OBISPO MERCY HEALTHCARE BAKERSFIELD 2215 TRUXTUN AVE BAKERSFIELD CA 93301 KERN DELANO REGIONAL MEDICAL CENTER 1401 GARCES HWY DELANO CA 93215 KERN GOOD SAMARITAN HOSPITAL 901 OLIVE DR BAKERSFIELD CA 93308 KERN KERN MEDICAL CENTER 1700 MOUNT VERNON AVE BAKERSFIELD CA 93306 KERN SAN JOAQUIN COMMUNITY HOSPITAL 2615 CHESTER AVE BAKERSFIELD CA 93301 KERN NORTHRIDGE HOSPITAL MEDICAL CENTER 18300 ROSCOE BLVD NORTHRIDGE CA 91325 CEDARS SINAI MEDICAL CENTER 8700 BEVERLY BLVD CA 90048 CHILDRENS HOSPITAL 4650 W SUNSET BLVD CA 90027 ENCINO HOSPITAL MEDICAL CENTER 16237 VENTURA BLVD ENCINO CA 91436 GLENDALE ADVENTIST MEDICAL CENTER 1509 WILSON TER GLENDALE CA 91206 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 23845 MCBEAN PKWY VALENCIA CA 91355 HOLLYWOOD COMMUNITY HOSPITAL AT BROTMAN 3828 DELMAS TER CULVER CITY CA 90232 HOLLYWOOD PRESBYTERIAN MEDICAL CENTER 1300 N VERMONT AVE CA 90027 MARINA DEL REY HOSPITAL 4650 LINCOLN BLVD MARINA DEL REY CA 90292 MIRACLE MILE MEDICAL CENTER 6000 SAN VICENTE BLVD CA 90036 MISSION COMMUNITY HOSPITAL-PANORAMA CAMPUS 14850 ROSCOE BLVD PANORAMA CITY CA 91402 OLYMPIA MEDICAL CENTER 5900 W OLYMPIC BLVD CA 90036 PACIFICA HOSPITAL OF THE VALLEY 9449 SAN FERNANDO RD SUN VALLEY CA 91352 PROVIDENCE HOLY CROSS MEDICAL CENTER 15031 RINALDI ST MISSION HILLS CA 91345 PROVIDENCE SAINT JOSEPH MEDICAL CENTER 501 S BUENA VISTA ST BURBANK CA 91505 PROVIDENCE TARZANA MEDICAL CENTER 18321 CLARK ST TARZANA CA 91356 RONALD REAGAN UCLA MEDICAL CENTER 757 WESTWOOD PLZ CA 90095 SANTA MONICA UCLA MEDICAL CENTER 1250 16TH ST SANTA MONICA CA 90404 SHERMAN OAKS HOSPITAL 4929 VAN NUYS BLVD SHERMAN OAKS CA 91403 SIMI VALLEY HOSPITAL 2975 SYCAMORE DR SIMI VALLEY CA 93065 VENTURA ST JOHNS HOSPITAL AND HEALTH CENTER 1328 22ND ST SANTA MONICA CA 90404 ST VINCENT MEDICAL CENTER 2131 W 3RD ST CA 90057 TEMPLE COMMUNITY HOSPITAL 235 N HOOVER ST CA 90004 VALLEY PRESBYTERIAN HOSPITAL 15107 VANOWEN ST VAN NUYS CA 91409 WEST HILLS HOSPITAL & MEDICAL CENTER 7300 MEDICAL CENTER DR WEST HILLS CA 91307 Page 4
ST BERNARDINE MEDICAL CENTER 2101 N WATERMAN AVE SN BERNRDNO CA 92404 SAN BERNARDINO LOMA LINDA UNIVERSITY MEDICAL CENTER 11234 ANDERSON ST LOMA LINDA CA 92354 SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL 29101 HOSPITAL ROAD LK ARROWHEAD CA 92352 SAN BERNARDINO PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER 3865 JACKSON ST RIVERSIDE CA 92503 RIVERSIDE REDLANDS COMMUNITY HOSPITAL 350 TERRACINA BLVD REDLANDS CA 92373 SAN BERNARDINO RIVERSIDE COMMUNITY HOSPITAL 4445 MAGNOLIA AVE RIVERSIDE CA 92501 RIVERSIDE SAN ANTONIO COMMUNITY HOSPITAL 999 SAN BERNARDINO RD UPLAND CA 91786 SAN BERNARDINO SAN GORGONIO MEMORIAL HOSPITAL 600 N HIGHLAND SPRINGS BANNING CA 92220 RIVERSIDE ST JOHNS PLEASANT VALLEY HOSPITAL 2309 ANTONIO AVE CAMARILLO CA 93010 VENTURA COMMUNITY MEMORIAL HOSPITAL SAN BUENAVENTURA 147 N BRENT ST VENTURA CA 93003 VENTURA LOS ROBLES REGIONAL MEDICAL CENTER 215 W JANSS RD THOUSAND OAKS CA 91360 VENTURA OJAI VALLEY COMMUNITY HOSPITAL 1306 MARICOPA HWY OJAI CA 93023 VENTURA SANTA PAULA HOSPITAL 825 N TENTH ST SANTA PAULA CA 93060 VENTURA SIMI VALLEY HOSPITAL 2975 SYCAMORE DR SIMI VALLEY CA 93065 VENTURA VENTURA COUNTY MEDICAL CENTER 3291 LOMA VISTA RD VENTURA CA 93003 VENTURA ST JOHNS REGIONAL MEDICAL CENTER 1600 N ROSE AVE OXNARD CA 93030 VENTURA COMMUNITY MEMORIAL HOSPITAL SAN BUENAVENTURA 147 N BRENT ST VENTURA CA 93003 VENTURA LOS ROBLES REGIONAL MEDICAL CENTER 215 W JANSS RD THOUSAND OAKS CA 91360 VENTURA OJAI VALLEY COMMUNITY HOSPITAL 1306 MARICOPA HWY OJAI CA 93023 VENTURA SANTA PAULA HOSPITAL 825 N TENTH ST SANTA PAULA CA 93060 VENTURA VENTURA COUNTY MEDICAL CENTER 3291 LOMA VISTA RD VENTURA CA 93003 VENTURA ST MARY MEDICAL CENTER - LONG BEACH 1050 LINDEN AVE LONG BEACH CA 90813 ANAHEIM GENERAL HOSPITAL 3350 W BALL RD ANAHEIM CA 92804 ORANGE CHILDRENS HOSPITAL OF ORANGE COUNTY 455 S MAIN ST ORANGE CA 92868 ORANGE COASTAL COMMUNITIES HOSPITAL 2701 S BRISTOL ST SANTA ANA CA 92704 ORANGE COMMUNITY HOSPITAL LONG BEACH 1720 TERMINO AVE LONG BEACH CA 90804 DOWNEY REGIONAL MEDICAL CENTER - HOSPITAL INC 11500 BROOKSHIRE AVE DOWNEY CA 90241 FOUNTAIN VALLEY REGIONAL HOSPITAL AND MEDICAL CENTER 17100 EUCLID ST FOUNTAIN CA 92708 ORANGE GARDEN GROVE HOSPITAL AND MEDICAL CENTER 12601 GARDEN GROVE GARDEN GROVE CA 92843 ORANGE HUNTINGTON BEACH HOSPITAL 17772 BEACH BLVD HUNTINGTN BCH CA 92647 ORANGE LA PALMA INTERCOMMUNITY HOSPITAL LLC 7901 WALKER ST LA PALMA CA 90623 ORANGE LAKEWOOD REGIONAL MEDICAL CENTER 3700 SOUTH ST LAKEWOOD CA 90712 LONG BEACH MEMORIAL MEDICAL CENTER 2801 ATLANTIC AVE LONG BEACH CA 90806 LOS ALAMITOS MEDICAL CENTER 3751 KATELLA AVE LOS ALAMITOS CA 90720 ORANGE MARINA DEL REY HOSPITAL 4650 LINCOLN BLVD MARINA DEL REY CA 90292 Page 5
MILLER CHILDRENS HOSPITAL 2801 ATLANTIC AVE LONG BEACH CA 90806 ORANGE COAST MEMORIAL MEDICAL CENTER 9920 TALBERT AVE FOUNTAIN CA 92708 ORANGE PACIFIC HOSPITAL OF LONG BEACH 2776 PACIFIC AVE LONG BEACH CA 90806 PROMISE HOSP OF EAST SUBURBAN CAMPUS 16453 COLORADO AVE PARAMOUNT CA 90723 PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO 1300 W 7TH ST SAN PEDRO CA 90732 PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER TORRANCE 4101 TORRANCE BLVD TORRANCE CA 90503 ST FRANCIS MEDICAL CENTER 3630 E IMPERIAL HWY LYNWOOD CA 90262 ST JOSEPH HOSPITAL - ORANGE 1100 W STEWART DR ORANGE CA 92868 ORANGE TORRANCE MEMORIAL MEDICAL CENTER 3330 LOMITA BLVD TORRANCE CA 90505 TRI CITY REGIONAL MEDICAL CENTER 21530 PIONEER BLVD HAWAIIAN CA 90716 UC IRVINE MEDICAL CENTER 101 CITY DRIVE S ORANGE CA 92868 ORANGE WEST ANAHEIM MEDICAL CENTER 3033 W ORANGE AVE ANAHEIM CA 92804 ORANGE WHITE MEMORIAL MEDICAL CENTER 1720 E CESAR E CHAVEZ AVE CA 90033 Dignity Health - Northern Regional Hospitals DOMINICAN SANTA CRUZ HOSPITAL 1555 SOQUEL DR SANTA CRUZ CA 95065 SANTA CRUZ GOOD SAMARITAN HOSPITAL 2425 SAMARITAN DR SAN JOSE CA 95124 SANTA CLARA OCONNOR HOSPITAL 2105 FOREST AVE SAN JOSE CA 95128 SANTA CLARA SANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM 751 S BASCOM AVE SAN JOSE CA 95128 SANTA CLARA WATSONVILLE COMMUNITY HOSPITAL 75 NEILSON ST WATSONVILLE CA 95076 SANTA CRUZ MARK TWAIN ST JOSEPHS HOSPITAL 768 MOUNTAIN RANCH RD SAN ANDREAS CA 95249 CALAVERAS SUTTER AMADOR HOSPITAL 200 MISSION BLVD JACKSON CA 95642 AMADOR SONORA REGIONAL MEDICAL CENTER 1 S FOREST RD SONORA CA 95370 TUOLUMNE MERCY GENERAL HOSPITAL 4001 J ST SACRAMENTO CA 95819 SACRAMENTO UC DAVIS MEDICAL CENTER 2315 STOCKTON BLVD SACRAMENTO CA 95817 SACRAMENTO MERCY HOSPITAL OF FOLSOM 1650 CREEKSIDE DR FOLSOM CA 95630 SACRAMENTO MARSHALL MEDICAL CENTER 1100 MARSHALL WAY PLACERVILLE CA 95667 EL DORADO UC DAVIS MEDICAL CENTER 2315 STOCKTON BLVD SACRAMENTO CA 95817 SACRAMENTO MERCY MEDICAL CENTER MT SHASTA 914 PINE ST MOUNT SHASTA CA 96067 SISKIYOU FAIRCHILD MEDICAL CENTER 444 BRUCE ST YREKA CA 96097 SISKIYOU SHASTA REGIONAL MEDICAL CENTER 1100 BUTTE ST REDDING CA 96001 SHASTA Page 6
MERCY MEDICAL CENTER REDDING 2175 ROSALINE AVE REDDING CA 96001 SHASTA NORTHERN CALIFORNIA REHABILITATION HOSPITAL 2801 EUREKA WAY REDDING CA 96001 SHASTA PATIENTS HOSPITAL OF REDDING 2900 EUREKA WAY REDDING CA 96001 SHASTA TRINITY HOSPITAL 60 EASTER AVE WEAVERVILLE CA 96093 TRINITY SHASTA REGIONAL MEDICAL CENTER 1100 BUTTE ST REDDING CA 96001 SHASTA MERCY MEDICAL CENTER MERCED 301 E 13TH ST MERCED CA 95340 MERCED EMANUEL MEDICAL CENTER 825 DELBON AVE TURLOCK CA 95382 STANISLAUS MADERA COMMUNITY HOSPITAL 1250 E ALMOND AVE MADERA CA 93637 MADERA MERCY SAN JUAN HOSPITAL 6501 COYLE AVE CARMICHAEL CA 95608 SACRAMENTO UC DAVIS MEDICAL CENTER 2315 STOCKTON BLVD SACRAMENTO CA 95817 SACRAMENTO METHODIST HOSPITAL OF SACRAMENTO 7500 HOSPITAL DR SACRAMENTO CA 95823 SACRAMENTO UC DAVIS MEDICAL CENTER 2315 STOCKTON BLVD SACRAMENTO CA 95817 SACRAMENTO SEQUOIA HEALTH SERVICES 170 DE LAS REDWOOD CITY CA 94062 EL CAMINO HOSPITAL 2500 GRANT RD MOUNTAIN VIEW CA 94040 SANTA CLARA LUCILE SALTER PACKARD CHILDRENS HOSPITAL OF STANFORD 725 WELCH RD PALO ALTO CA 94304 SANTA CLARA MENLO PARK SURGICAL HOSPITAL 570 WILLOW RD MENLO PARK CA 94025 MILLS HOSPITAL 100 S DR CA 94401 PENINSULA HOSPITAL & MEDICAL CENTER 1783 EL CAMINO REAL BURLINGAME CA 94010 COUNTY GEN HOSP 222 W 39TH AVE CA 94403 ST ROSE HOSPITAL 27200 CALAROGA AVE HAYWARD CA 94545 STANFORD UNIVERSITY HOSPITAL 300 PASTEUR DR PALO ALTO CA 94305 SANTA CLARA Terminating Hospital street addr city state zip SIERRA NEVADA MEMORIAL HOSPITAL 155 GLASSON WAY GRASS VALLEY CA 95945 Alternate Hospitals street addr city state zip code RIDEOUT MEMORIAL HOSPITAL 726 4TH ST MARYSVILLE CA 95901 Terminating Hospital street addr city state zip code ST ELIZABETH COMMUNITY HOSPITAL 2550 SISTER MARY RED BLUFF CA 96080 ENLOE MEDICAL CENTER INC 1531 ESPLANADE CHICO CA 95926 GLENN MEDICAL CENTER 1133 W SYCAMORE ST WILLOWS CA 95988 Page 7 NEVADA YUBA TEHAMA BUTTE GLENN
NORTHERN CALIFORNIA REHABILITATION HOSPITAL 2801 EUREKA WAY REDDING CA 96001 PATIENTS HOSPITAL OF REDDING 2900 EUREKA WAY REDDING CA 96001 SHASTA REGIONAL MEDICAL CENTER 1100 BUTTE ST REDDING CA 96001 SHASTA SHASTA SHASTA Terminating Hospital street addr city state zip ST FRANCIS MEMORIAL HOSPITAL 900 HYDE ST CA 94109 HOSPITAL 2070 CLINTON AVE CA 94501 ALTA BATES SUMMIT MC-ALTA BATES/HERRICK CAMPUS 2450 ASHBY AVE BERKELEY CA 94705 ALTA BATES SUMMIT MC-SUMMIT CAMPUS 350 HAWTHORNE AVE OAKLAND CA 94609 CALIFORNIA PACIFIC MEDICAL CENTER - DAVIES CAMPUS CASTRO AND DUBOCE CA 94114 CALIFORNIA PACIFIC MEDICAL CENTER-CALIFORNIA CAMPUS 3700 CALIFORNIA ST CA 94118 CALIFORNIA PACIFIC MEDICAL CENTER-PACIFIC CAMPUS CLAY AT BUCHANAN CA 94115 CALIFORNIA PACIFIC MEDICAL CENTER-ST LUKES CAMPUS 3555 CESAR CHAVEZ CA 94110 CHILDRENS HOSPITAL OAKLAND 747 52ND ST OAKLAND CA 94609 CHINESE HOSPITAL 845 JACKSON ST CA 94133 DOCTORS MEDICAL CENTER-SAN PABLO/PINOLE 2000 VALE RD SAN PABLO CA 94806 MARIN GENERAL HOSPITAL 250 BON AIR RD GREENBRAE CA 94904 MILLS HOSPITAL 100 S DR CA 94401 PENINSULA HOSPITAL & MEDICAL CENTER 1783 EL CAMINO REAL BURLINGAME CA 94010 SAN LEANDRO HOSPITAL CAMPUS 13855 E 14TH ST SAN LEANDRO CA 94578 SETON MEDICAL CENTER 1900 SULLIVAN AVE DALY CITY CA 94015 UCSF BENIOFF CHILDREN S HOSPITAL 505 PARNASSUS AVE CA 94143 UCSF MEDICAL CENTER 505 PARNASSUS AVE CA 94143 Terminating Hospital street addr city state zip ST JOSEPHS MEDICAL CENTER OF STOCKTON 1800 N CALIFORNIA ST STOCKTON CA 95204 code DAMERON HOSPITAL 525 W ACACIA ST STOCKTON CA 95203 DOCTORS HOSPITAL OF MANTECA INC 1205 E NORTH ST MANTECA CA 95336 LODI MEMORIAL HOSPITAL 975 S FAIRMONT AVE LODI CA 95240 Terminating Hospital street addr city state zip code ST MARYS MEDICAL CENTER 450 STANYAN ST CA 94117 HOSPITAL 2070 CLINTON AVE CA 94501 ALTA BATES SUMMIT MC-ALTA BATES/HERRICK CAMPUS 2450 ASHBY AVE BERKELEY CA 94705 ALTA BATES SUMMIT MC-SUMMIT CAMPUS 350 HAWTHORNE AVE OAKLAND CA 94609 CALIFORNIA PACIFIC MEDICAL CENTER - DAVIES CAMPUS CASTRO AND DUBOCE CA 94114 CALIFORNIA PACIFIC MEDICAL CENTER-CALIFORNIA CAMPUS 3700 CALIFORNIA ST CA 94118 CALIFORNIA PACIFIC MEDICAL CENTER-PACIFIC CAMPUS CLAY AT BUCHANAN CA 94115 CALIFORNIA PACIFIC MEDICAL CENTER-ST LUKES CAMPUS 3555 CESAR CHAVEZ CA 94110 CHILDRENS HOSPITAL OAKLAND 747 52ND ST OAKLAND CA 94609 CHINESE HOSPITAL 845 JACKSON ST CA 94133 DOCTORS MEDICAL CENTER-SAN PABLO/PINOLE 2000 VALE RD SAN PABLO CA 94806 MARIN GENERAL HOSPITAL 250 BON AIR RD GREENBRAE CA 94904 Page 8 CONTRA COSTA MARIN SAN JOAQUIN SAN JOAQUIN SAN JOAQUIN SAN JOAQUIN CONTRA COSTA MARIN
MILLS HOSPITAL 100 S DR CA 94401 PENINSULA HOSPITAL & MEDICAL CENTER 1783 EL CAMINO REAL BURLINGAME CA 94010 SETON MEDICAL CENTER 1900 SULLIVAN AVE DALY CITY CA 94015 UCSF BENIOFF CHILDREN S HOSPITAL 505 PARNASSUS AVE CA 94143 UCSF MEDICAL CENTER 505 PARNASSUS AVE CA 94143 Terminating Hospital street addr city state zip code WOODLAND MEMORIAL HOSPITAL 1325 COTTONWOOD ST WOODLAND CA 95695 UC DAVIS MEDICAL CENTER 2315 STOCKTON BLVD SACRAMENTO CA 95817 YOLO SACRAMENTO Page 9