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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

EMANATE HEALTH INTER-COMMUNITY HOSPITAL

210 W. SAN BERNARDINO ROAD
COVINA, CA 91723
http://cvhp.org

License:

General Acute Care Hospital
Total Beds: 191
Emergency Room: Yes
more... Link to Atlas

Contact:

Sally De La O
(626) 732-3105

OSHPD ID:

106190413

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

4/24/2002

Download:

Federal Poverty Level for Free Care:

300%

Discount Payment Effective Date:

5/12/1999

Discount Payments

FPL Range: 301%-325%
Payment Basis:
Other: Patient responsible for 25% of total bill.

FPL Range: 326%-350%
Payment Basis:
Other: Patient responsible for 50% of total bill.

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

12/27/2007

Download:

Income Type Used:

Salary Received

Language Information

Available Languages:

English
Spanish

Additional Information

Family Size	100%	150%	200%	250%	300%	350%	400%