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Policy Effective Date (Date Posted):

Download: Policy File

Download: Application File

General Information

Hospital:

SAN DIMAS COMMUNITY HOSPITAL

1350 WEST COVINA BOULEVARD
SAN DIMAS, CA 91773
http://www.sandimashospital.com

License:

General Acute Care Hospital
Total Beds: 101
Emergency Room: Yes
more... Link to Atlas

Contact:

MONIQUE PADILLA
(909) 292-9451

OSHPD ID:

106190673

Fair Pricing Policy Information Show FPL Chart

Policy Effective Date:

4/1/2020

Download:

Federal Poverty Level for Free Care:

400%

Discount Payment Effective Date:

4/1/2020

Discount Payments

FPL Range: 400%-450%
Payment Basis:
Medicare
Medi-Cal

FPL Range: 0%-0%
Payment Basis:

FPL Range: 0%-0%
Payment Basis:

Other Discount Payment Information:

Application Form Information

Application Form Eff Date:

4/1/2020

Download:

Income Type Used:

Salary Received
Interest Received
Pension Received
Other: TOTAL YEARLY INCOME FOR PATIENT AND SPOUSE

Language Information

Available Languages:

English
Spanish
Vietnamese

Additional Information

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